NPIMap

Organization Active NPI

Columbus Regional Health Network

  • Family Medicine Physician
  • Tabor City, NC
National Provider Identifier
1629318886
Registry record updated Oct 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COLUMBUS REGIONAL HEALTH NETWORK
Practice address
14508 James B White Hwy S
Tabor City, NC 28463-8358
Phone
(910) 653-7000
Fax
(910) 653-7004
NPI assigned
Feb 26, 2013
Organization subpart
Yes
Parent organization
COLUMBUS REGIONAL HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2013

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

Authorized official

Name
Daniel L. Wiens
Title
Senior Vice President/Operations
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

14508 James B White Hwy S
Tabor City, NC 28463-8358

Mailing address

PO Box 602530
Charlotte, NC 28260-2530
Phone (910) 653-7000

Other identifiers 1

IdentifierTypeStateIssuer
1629318886MedicaidNC

Other names 1

  • South Columbus Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090424000511 NC Part B Supplier - Clinic/Group Practice 6608924931 Receives reassigned benefits from 248 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tabor City, NC; Wadesboro, NC; Whiteville, NC; Wilmington, NC; Monroe, NC; Shelby, NC; Albemarle, NC; Charlotte, NC…

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Christy T Perdue MD PA

Practitioners & affiliated clinicians

Practitioners 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1361836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382054400000",
    "number": "1629318886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602530",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602530",
            "telephone_number": "910-653-7000",
            "fax_number": "910-635-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14508 JAMES B WHITE HWY S",
            "city": "TABOR CITY",
            "state": "NC",
            "postal_code": "284638358",
            "telephone_number": "910-653-7000",
            "fax_number": "910-653-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBUS REGIONAL HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBUS REGIONAL HEALTH NETWORK",
        "enumeration_date": "2013-02-26",
        "last_updated": "2013-10-18",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT/OPERATIONS",
        "authorized_official_telephone_number": "704-355-0648"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629318886",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Columbus Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tabor City, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.