NPIMap

Organization Active NPI

Longleaf Neuro Medical Treatment Center

  • Long Term Care Pharmacy
  • Wilson, NC
National Provider Identifier
1710038732
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
02460 Issued in NC
Legal business name
LONGLEAF NEURO MEDICAL TREATMENT CENTER
Practice address
4761 Ward Blvd
Wilson, NC 27893-4359
Phone
(252) 399-2109
Fax
(252) 399-2136
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Karen Burkes
Title
Division Director
Phone
(919) 855-4700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X 02460 NC Primary

Addresses

Primary practice location

4761 Ward Blvd
Wilson, NC 27893-4359

Mailing address

4761 Ward Blvd
Wilson, NC 27893-4359
Phone (252) 399-2109

Other identifiers 3

IdentifierTypeStateIssuer
3406177MedicaidNC
3405192MedicaidNC
2066141OtherPK

Other names 1

  • LONGLEAF NEURO MEDICAL TREATMENT CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Longleaf Neuro-Medical Treatment Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4761 Ward Blvd
Wilson, NC 27893
Phone (252) 399-2112

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1710038732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4761 WARD BLVD",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934359",
            "telephone_number": "252-399-2109",
            "fax_number": "252-399-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4761 WARD BLVD",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278934359",
            "telephone_number": "252-399-2109",
            "fax_number": "252-399-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGLEAF NEURO MEDICAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "BURKES",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "DIVISION DIRECTOR",
        "authorized_official_telephone_number": "919-855-4700"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NC",
            "license": "02460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406177",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405192",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2066141",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LONGLEAF NEURO MEDICAL TREATMENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LONGLEAF NEURO MEDICAL TREATMENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.