Scotland Memorial Hospital, Inc
Organization Active NPI Rural Health Clinic/Center · Wagram, NC
NPI 1891789970 · NPPES record last updated Aug 31, 2022
Key facts
- NPI
- 1891789970
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SCOTLAND MEMORIAL HOSPITAL, INC
- Practice address
- 24420 Marlboro St
Wagram, NC 28396-9600 - Phone
- (910) 369-3136
- Fax
- (910) 369-4756
- NPI assigned
- Sep 6, 2005
- Organization subpart
- No
Authorized official
- Name
- Lucien Stonge
- Title
- Cfo
- Phone
- (910) 291-7547
Owners & managing parties with NPI records 3
-
Glenn Ray Harris, MD
-
Kurt Andrew Jute, D.O.
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 10
Related certifications (CCN) 1
Facilities with the same owner 8
Practitioners 261
-
Latonya Armstrong, CNM
-
Matthew T Manzo, DO
-
Olufunsho Adamolekun, D.O
-
Harry T Ameredes, M.D.
-
Robert A Appel, M.D.
-
Fernando E Ariza, MD
-
Clinton Kesler Atkinson, M.D.
-
Kimberly June Ball, CRNA
-
Demir E Bastug, M.D.
-
Alex David Bibbey, M.D.
-
Barry Bodie, MD
-
Tracy Bowman, PA
-
Luke Pierson Brooks, PA-C
-
Michael L Bruin, MD
-
Esther Cassidy, CRNA
-
Paula Y Chang, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Rural health clinic certification: CCN 343475
- Legal name
- SCOTLAND MEMORIAL HOSPITAL, INC
- Doing business as
- WAGRAM FAMILY PRACTICE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 27, 2021
- Last certification
- Jul 27, 2021
- Ownership / control type
- 1B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 26, 1947 in NC
- Enrollment address
- 24420 Marlboro St
Wagram, NC 28396-9600 - Related CCNs
- 340008
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Jessica B Scott |
Corporate Director | Oct 1, 2019 | |
| Ravonda Sue John |
Corporate Director |
Oct 1, 2019 | |
| Gregory Clark Wood |
Contracted Managing Employee | Apr 1, 2009 | |
| Corporate Officer |
Apr 1, 2009 | ||
| Matthew David Pracht |
Corporate Officer |
Apr 1, 2009 | |
| Corporate Director |
Apr 1, 2009 | ||
| W-2 Managing Employee |
Apr 1, 2009 | ||
| David Harling |
Corporate Director |
Jan 1, 2010 | |
| John a Ferguson |
Corporate Director | Oct 1, 2020 | |
| James Roy McCook |
Corporate Director |
Oct 1, 2020 | |
| Bradley Williams |
Corporate Director |
Jan 1, 2019 | |
| Kenneth Nichols |
Corporate Director |
Jan 1, 2006 | |
| Hampton Howard Hubbard |
Corporate Director |
Oct 1, 2020 | |
| Wilbur Gene Shytle |
Corporate Director |
Jan 1, 2013 | |
| Kurt Jute |
Corporate Director |
Oct 1, 2020 | |
| Scott B Andrews |
Corporate Director | Jan 1, 2018 | |
| Robert N Hinson |
Corporate Director |
Jan 1, 2014 | |
| Rebecca Hughes |
Corporate Director |
Jan 1, 2019 | |
| Ralph E Carter |
Corporate Director |
Oct 1, 2020 | |
| Sybil J Bullard |
Corporate Director | Jan 1, 2019 | |
| Charlotte-Mecklenburg Hospital Authority |
Operational/Managerial Control | Apr 1, 2009 | |
| Glenn Ray Harris |
Corporate Director |
Jan 1, 2017 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Marlboro Family Practice and Urgent Care |
Rural health clinic | Operational/Managerial Control | Dec 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000382 | NC | Part B Supplier - Clinic/Group Practice | 0648208504 |
Receives reassigned benefits from 492 practitioners 11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Laurinburg, NC; Wagram, NC; Pembroke, NC |
| O20210426002437 | NC | Part a Provider - Rural Health Clinic | 0648208504 | Practice locations: Wagram, NC |
National Provider Directory
Locations
24220 Marlboro St
Wagram, NC 28396
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
24420 Marlboro St
Wagram, NC 28396-9600
Mailing address
24420 Marlboro St
Wagram, NC 28396-9600
Phone (910) 369-3136
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07171 | Other | NC | BCBS |
| 89018PZ | Medicaid | NC | |
| 891261T | Medicaid | NC | |
| NPB192 | Medicaid | SC |
Other names
- Wagram Family Practice
Other providers in Wagram, NC
- Rolanda Faulk Jones
- Linda Marie McLaughlin
- Dana Latoya McQueen Whitfield
- Sherry L. Oxendine
- Cassandra Ann Hartley Pennington
- Scotland Regional Health Network
- Southern Heart Home Care
- Sunshine Center
- Sunshine Center, Inc.
- Mary Ann Todd
All providers in Wagram, NC · Rural Health Clinic/Center 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 Aug 31, 2022. 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.