NPIMap

Organization Active NPI

Shallotte Medical Center Inc

  • Family Medicine Physician
  • Shallotte, NC
National Provider Identifier
1609845049
Registry record updated Feb 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SHALLOTTE MEDICAL CENTER INC
Practice address
341-A Whiteville Rd
Shallotte, NC 28470
Phone
(910) 754-8731
Fax
(910) 754-3153
NPI assigned
Mar 17, 2006
Last updated
Feb 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bernard Leroy Langston III, MD
Title
President
Phone
(910) 754-8731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

341-A Whiteville Rd
Shallotte, NC 28470

Mailing address

PO Box 2561
Shallotte Medical Center Inc
Shallotte, NC 28459
Phone (910) 754-8731

Other identifiers 1

IdentifierTypeStateIssuer
344615AMedicaidNC

National Provider Directory

National Provider Directory

Locations

146 Poole Rd
Leland, NC 28451
Phone (910) 371-1600

710 Sunset Blvd N
Sunset Beach, NC 28468
Phone (910) 575-3923

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1609845049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2561",
            "address_2": "SHALLOTTE MEDICAL CENTER INC",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "28459",
            "telephone_number": "910-754-8731",
            "fax_number": "910-754-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341-A WHITEVILLE RD",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "28470",
            "telephone_number": "910-754-8731",
            "fax_number": "910-754-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALLOTTE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "LANGSTON",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-754-8731",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344615A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shallotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.