Organization
PINEHURST MEDICAL CLINIC INC
Active
Parent organization
PINEHURST MEDICAL CLINIC, INC
Other names
Lumber River Cardiology
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINEHURST MEDICAL CLINIC, INC
Authorized official
MR. CYRUS J FAIRCLOTH II (CEO)
(910) 295-5511
Entity
Organization
Contact information
Practice address
705B LAUCHWOOD DRIVE, LAURINBURG, NC 28352-5544
(910) 266-0111
(910) 277-0055
Mailing address
705B LAUCHWOOD DRIVE, LAURINBURG, NC 28352-5544
(910) 266-0111
(910) 277-0055
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020R0
BC/BS NC GROUP PROVIDER#
NC
05
—
5950379
—
NC
01
—
CC6114
PALMETTO GBA GROUP PROVIDER#
—
01
—
NPB301
SC MEDICAID GROUP PROVIDER#
SC
Enumeration date
05/27/2008
Last updated
03/14/2022
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