Shallotte Medical Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SHALLOTTE MEDICAL CENTER INC

Practice address

3875 Business Hwy 17 E
Bolivia, NC 28422

Phone

(910) 253-7990

Fax

(910) 253-7990

NPI assigned

Mar 23, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bernard Leroy Langston III, MD

Title

President

Phone

(910) 754-8731

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bolivia Medical Center Doing business as

Locations

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1992764211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 409",
            "address_2": "BOLIVIA MEDICAL CENTER",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "28422",
            "telephone_number": "910-253-7990",
            "fax_number": "910-253-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 BUSINESS HWY 17 E",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "28422",
            "telephone_number": "910-253-7990",
            "fax_number": "910-253-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALLOTTE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2008-02-05",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343928A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolivia Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Anthony Saracino, M.D.
• Richard Ralph Scallion, MD
• David Brian Schmitz, DO
• Ashton Jaice Scruggs-Poole
• Justin Sempsrott
• Craig S Shapiro, DMD
• Jane Anne Shaw, DO
• Michelle L Shepherd, CRNA
• Melissa Sherrod, PA-C
• William Sherrod, M.D.

• All providers in Bolivia, NC
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.