Goldsboro Medical Clinic

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

9600773 Issued in NC

Legal business name

GOLDSBORO MEDICAL CLINIC

Practice address

2400 Wayne Memorial Dr
Suite 1
Goldsboro, NC 27534-1789

Phone

(919) 739-9060

NPI assigned

Oct 28, 2009

Last updated

Oct 23, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Tri - State Medical Group Inc

Practitioners 2

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.

• Howard W Newell Jr., MD

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1457310971
  NPD
• Thaddeus C West Jr., MD

  • Internal Medicine Physician
  • Goldsboro, NC
  • NPI 1932169034
  NPD

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

{
    "created_epoch": "1256688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1851627780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 WAYNE MEMORIAL DR",
            "address_2": "SUITE 1",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275341789",
            "telephone_number": "919-739-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDSBORO MEDICAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2009-10-28",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NC",
            "license": "9600773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Goldsboro Family Physicians, P.a.
• Goldsboro Family Young Men's Christian Association
• Goldsboro House of Hope LLC
• Goldsboro Internal Medicine and Med-Spa PLLC
• Goldsboro Medical Center, P.a.
• Goldsboro Medical Clinic PA
• Goldsboro Medical Specialists PA
• Goldsboro Neurological Surgery, PA
• Goldsboro OB-GYN, Associates, PLLC
• Goldsboro Opco LLC

• Non-Pharmacy Dispensing Site in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Non-Pharmacy Dispensing Site in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.