Goshen Medical Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Dunn, NC
NPI 1780193557 · NPPES record last updated Dec 16, 2024
Key facts
- NPI
- 1780193557
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GOSHEN MEDICAL CENTER, INC
- Practice address
- 801 Tilghman Dr Ste a
Dunn, NC 28334-4958 - Phone
- (910) 892-6500
- Fax
- (910) 302-5897
- NPI assigned
- Sep 25, 2017
- Organization subpart
- No
Authorized official
- Name
- Greg Bounds
- Title
- Ceo
- Phone
- (910) 267-2042
Other NPIs on the same Medicare enrollment 44
Practitioners 10
-
Angela Maria Bryant, FNP-C
-
Karen Ann Chavis, FNP-C
-
Debra Kosko, NP
-
Michael Stempek, PA
-
Mackinsey Diane Johnson, PA-C
-
Madelyn Shel Norris, PA-C
-
Golfran Alejandro Rivera, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Federally qualified health center certification: CCN 341083
- Legal name
- GOSHEN MEDICAL CENTER INCORPORATED
- Doing business as
- GOSHEN MEDICAL CENTER - DUNN
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 21, 2018
- Last certification
- Mar 21, 2018
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 29, 1979 in NC
- Enrollment address
- 801 Tilghman Dr
Ste a
Dunn, NC 28334-4958
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Rhonda Barwick |
W-2 Managing Employee |
Dec 4, 2017 | |
| Chester Aycock |
Corporate Director |
Feb 1, 2006 | 100% |
| Tanty Freeman |
Corporate Director |
Feb 1, 2008 | 100% |
| Patricia a Davis |
Corporate Director |
Feb 1, 2008 | 100% |
| Gregory M Bounds |
Corporate Officer |
Jan 2, 2004 | |
| W-2 Managing Employee |
Jan 2, 2004 | ||
| Operational/Managerial Control |
Jan 2, 2004 | ||
| Goshen Medical Center Incorporated |
5% Or Greater Direct Ownership Interest | Dec 4, 2017 | 100% |
| Charlotte W Graham |
Corporate Director |
Feb 1, 2008 | 100% |
| Diane H Graham |
Corporate Officer |
Dec 27, 2007 | |
| W-2 Managing Employee |
Dec 27, 2007 | ||
| Operational/Managerial Control |
Dec 27, 2007 | ||
| Betty S Rose |
Corporate Director |
Jan 2, 2011 | 100% |
| James Roa |
Corporate Director |
Feb 1, 2008 | 100% |
| Mattie P Atkinson |
Corporate Director |
Feb 1, 2008 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040102000726 | NC | Part B Supplier - Clinic/Group Practice | 3173434479 |
Receives reassigned benefits from 224 practitioners 45 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kenansville, NC; Morehead City, NC; Mount Olive, NC; New Bern, NC; Rockingham, NC; Rose Hill, NC; Sanford, NC; Southport, NC… |
| O20171220002667 | NC | Part a Provider - Federally Qualified Health Center (FQHC) | 3173434479 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Dunn, NC |
National Provider Directory
Locations
408 Fairview St
Clinton, NC 28328
Phone (910) 596-2400
801 Tilghman Dr
Ste A
Dunn, NC 28334
Phone (910) 892-6500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
801 Tilghman Dr Ste a
Dunn, NC 28334-4958
Mailing address
PO Box 187
Faison, NC 28341-0187
Phone (910) 267-2042
Other names
- Goshen Medical Center - Dunn
Other providers in Dunn, NC
- Sara Ward Gonzalez
- Good Samaratan Family Practice & Urgent Care, PLLC
- Cassandra Goodenough
- Sri Anjali Gorle
- Goshen Medical Center Incorporated
- Kathryn Gower
- Richard Martin Graveen
- Kellisha Gray
- Patrick Hampton Gray
- Greater Pathways, LLC
All providers in Dunn, NC · Federally Qualified Health Center (FQHC) in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.