NPIMap

Organization Active NPI

Chicora Medical Group PA

Doing business as Brunswick Speciality Services

  • Family Medicine Physician
  • Supply, NC
National Provider Identifier
1881663227
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CHICORA MEDICAL GROUP PA
Doing business as
Brunswick Speciality Services
Practice address
20 Medical Campus Dr
Ste 106B
Supply, NC 28462
Phone
(910) 754-8600
Fax
(910) 755-2364
NPI assigned
Mar 17, 2006
Last updated
Mar 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 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, MDNPI 1821066358
Title
President
Phone
(910) 754-8731

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

20 Medical Campus Dr
Ste 106B
Supply, NC 28462

Mailing address

PO Box 2528
Shallotte, NC 28459
Phone (910) 754-8600

Other names 1

  • Brunswick Speciality Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brunswick Speciality Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

20 Medical Campus Dr NW
Ste 106B
Supply, NC 28462
Phone (910) 754-8600

Practitioners & affiliated clinicians

Practitioners 15

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 15

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": "1205193600000",
    "number": "1881663227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2528",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "28459",
            "telephone_number": "910-754-8600",
            "fax_number": "910-755-2364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 MEDICAL CAMPUS DR",
            "address_2": "STE 106B",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "28462",
            "telephone_number": "910-754-8600",
            "fax_number": "910-755-2364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICORA MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2008-03-11",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brunswick Speciality Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Supply, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.