Breeches Buoy Addiction Medicine Services

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

Legal business name

BREECHES BUOY ADDICTION MEDICINE SERVICES

Practice address

300 W 27TH St
Lumberton, NC 28358-3075

Phone

(910) 536-1689

NPI assigned

Mar 4, 2021

Last updated

Mar 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marla HardenberghNPI 1962586214

Title

Owner

Phone

(208) 578-6110

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 4

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.

• Marla Jo Hardenbergh, MEDICAL DOCTOR

  • Obstetrics & Gynecology Physician
  • Lumberton, NC
  • NPI 1962586214

  Addiction Medicine

  Medicare reassignment NPD Authorized official
• Allison Locklear Jacobs, FNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lumberton, NC
  • NPI 1225303746
  Medicare reassignment Care Compare group NPD
• Heidi M Smith, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • Lumberton, NC
  • NPI 1629456330
  Medicare reassignment Care Compare group NPD
• Kelly Graham Wilkins, FNP-C, PMHNP-BC

  • Family Nurse Practitioner
  • Laurinburg, NC
  • NPI 1275819617
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1962097626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3870",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W 27TH ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583075",
            "telephone_number": "910-536-1689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREECHES BUOY ADDICTION MEDICINE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "HARDENBERGH",
        "authorized_official_first_name": "MARLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-578-6110"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Brady, RPH
• Amber Lynn Branch, MSW,LCASA,CADC,QP,BA
• Ciara Nicole Branch, FNP
• Brian M Bray
• Melinda Cook Brayboy, D.C.
• Eric Adam Breitbart, MD
• Danasia Brewer
• Katrina L. Brewington, SPEECH LANGUAGE PATH
• Bridges Group Home, Inc.
• Emily Ames Briley, MS SLP

• Addiction Medicine (Internal Medicine) Physician in Lumberton, NC
• Providers in Lumberton, NC by specialty
• Addiction Medicine (Internal Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.