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Scotland Memorial Hospital Inc

Organization Active NPI Rural Health Clinic/Center · Pembroke, NC

NPI 1508850447 · NPPES record last updated Sep 22, 2022

Key facts

NPI
1508850447
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SCOTLAND MEMORIAL HOSPITAL INC
Practice address
412 S. Jones St.
Pembroke, NC 28372
Phone
(910) 521-4462
Fax
(910) 521-7739
NPI assigned
Sep 7, 2005
Organization subpart
No

Authorized official

Name
Lucien Stonge
Title
Cfo
Phone
(910) 291-7547

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 260

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 260

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0245413Pembroke Family Practice & Urgent Care
412 S Jones Street, Pembroke, NC 28372		Provider-performed microscopyFeb 5, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC

Rural health clinic certification: CCN 343982

Legal name
SCOTLAND MEMORIAL HOSPITAL, INC
Doing business as
PEMBROKE FAMILY PRACTICE & URGENT CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 15, 1989
Last certification
Feb 24, 2021
Ownership / control type
2B
Organization structure
Corporation · Proprietary
Incorporated
Mar 15, 1989 in NC
Enrollment address
412 S Jones St
Pembroke, NC 28372-7261
Related CCNs
340008

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jessica B Scott
Individual 		Corporate Director
Board of Trustee		 Oct 1, 2019
Ravonda Sue John
Individual 		Corporate Director
Board of Trustee		 Oct 1, 2019
Gregory Clark Wood
Individual 		Corporate Director
President, Ceo		 Jun 27, 2003
Matthew David Pracht
Individual 		Corporate Director
VP, Cfo		 Jan 1, 1992
Mark a Hansman
Individual 		Corporate Director
Board of Trustee, Chief of Staff		 Jan 1, 2018
Christopher M Ward
Individual 		Corporate Officer
Board of Trustees		 Jan 1, 2019
David Harling
Individual 		Corporate Director Jan 1, 2010
Jane Rogers
Individual 		Corporate Director
Board of Trustee		 Jan 1, 2012
Bradley Williams
Individual 		Corporate Director
Board of Trustee		 Jan 1, 2019
Kenneth Nichols
Individual 		Corporate Director Jan 1, 2006
Douglas Frank Nederostek
Individual 		Corporate Director
Board of Trustee		 Oct 1, 2019
Ruth Bland
Individual 		W-2 Managing Employee Apr 1, 2008
Other Apr 1, 2008
Wilbur Gene Shytle
Individual 		Corporate Officer
Board of Trustees		 Jan 1, 2013
Scotland Health Care System
Organization · Laurinburg, NC 		5% Or Greater Direct Ownership Interest Nov 30, 1994
John Ray Nobles
Individual 		Corporate Director Jan 1, 2016
Scott B Andrews
Individual 		Corporate Director
Board of Trustee		 Jan 1, 2018
Robert N Hinson
Individual 		Corporate Director
Board of Trustee		 Jan 1, 2014
Rebecca Hughes
Individual 		Corporate Director
Board of Trustee		 Dec 1, 2018
Sybil J Bullard
Individual 		Corporate Director
Board of Trustee		 Dec 1, 2018
Charlotte-Mecklenburg Hospital Authority
Organization · Charlotte, NC 		Operational/Managerial Control Apr 1, 2009
Glenn Ray Harris
Individual 		Corporate Director
Board of Trustee		 Jan 1, 2017

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marlboro Family Practice and Urgent Care
Bennettsville, SC · CCN 423461		 Rural health clinic Operational/Managerial Control Dec 1, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20030627000007 NC Part a Provider - Rural Health Clinic 0648208504 Practice locations: Pembroke, NC
O20031105000382 NC Part B Supplier - Clinic/Group Practice 0648208504 Receives reassigned benefits from 492 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laurinburg, NC; Wagram, NC; Pembroke, NC

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NC Yes

Addresses

Primary practice location

412 S. Jones St.
Pembroke, NC 28372

Mailing address

PO Box 604093
Charlotte, NC 28260-4093
Phone (910) 291-7000

Other identifiers

IdentifierTypeStateIssuer
01512OtherNCBCBS
DE7674OtherNCRAILROAD MEDICARE
34-3982MedicaidNC

Other names

  • PEMBROKE FAMILY PRACTICE CENTER Doing business as
  • Pembroke Family Practice and Urgent Care Doing business as

Other providers in Pembroke, NC

All providers in Pembroke, NC · Rural Health Clinic/Center in North Carolina

Sources for this page

Verify at the official NPI Registry.