NPIMap

Organization Active NPI

Robeson Health Care Corporation

Doing business as Lumberton Family Dental

  • Federally Qualified Health Center (FQHC)
  • Lumberton, NC
National Provider Identifier
1972157220
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROBESON HEALTH CARE CORPORATION
Doing business as
Lumberton Family Dental
Practice address
1309 E 5TH St Ste a
Lumberton, NC 28358-6031
Phone
(910) 370-5031
Fax
(910) 370-5034
NPI assigned
Jul 25, 2019
Last updated
Dec 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Authorized official

Name
George Timothy Hall
Title
President/Ceo
Phone
(910) 521-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1309 E 5TH St Ste a
Lumberton, NC 28358-6031

Mailing address

60 Commerce Plaza Cir
Pembroke, NC 28372-7386
Phone (910) 521-2900

Other names 1

  • LUMBERTON FAMILY DENTAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031231000292 NC Part B Supplier - Clinic/Group Practice 1850290693 Receives reassigned benefits from 27 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Red Springs, NC; Smithfield, NC; Saint Pauls, NC; Pembroke, NC; Maxton, NC; Lumberton, NC; Fairmont, NC; Laurinburg, NC…
O20191002002641 NC Part A Provider - Federally Qualified Health Center (FQHC) 1850290693 Practice locations: Lumberton, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972157220. Details of each certification follow.

Federally qualified health center certification: CCN 341108

Legal name
ROBESON HEALTH CARE CORPORATION
Doing business as
LUMBERTON FAMILY DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 2, 2019
Last certification
Oct 2, 2019
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1985 in NC
Enrollment address
1309 E 5TH St
Lumberton, NC 28358-6031

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Robeson Health Care Corporation16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

1309 E 5th St
Ste A
Lumberton, NC 28358
Phone (910) 370-5031

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Henry Junior Shamburger Individual Other Mar 1, 2025
Michael L Hardin Individual OtherVice Chairman Mar 1, 2025
Bernice Graham Individual Other Jul 1, 2023
Melvin Ellison Individual Other Jan 1, 2024
George Timothy Hall Individual Corporate OfficerPresident/Ceo Feb 18, 2019
W-2 Managing EmployeePresident/Ceo Feb 18, 2019
Ryan Sampson Individual Other Jul 1, 2024
Kristy Lynn Locklear Individual Corporate OfficerChief Financial Officer Feb 18, 2019
W-2 Managing EmployeeChief Financial Officer Feb 18, 2019
Patricia L B Lewis Individual Other Apr 1, 2025
Mario Estrada Individual Other Apr 1, 2025
Denise Hunt Individual OtherTreasurer Nov 1, 2023
Sheena Marie Hunt Individual OtherBoard Chairman Feb 1, 2026

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1972157220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PLAZA CIR",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727386",
            "telephone_number": "910-521-2900",
            "fax_number": "910-775-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 E 5TH ST STE A",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283586031",
            "telephone_number": "910-370-5031",
            "fax_number": "910-370-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBESON HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-25",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "910-521-2900"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LUMBERTON FAMILY DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lumberton, NC

Sources for this page

Verify at the official NPI Registry.