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OPEN WATER MEDICAL, PA
NPI 1720550940
Clinic/Center in Goldsboro, NC

Active since December 28, 2018CLIA 34D0239917 · Microscopy
1209 E ASH ST, GOLDSBORO, NC 27530(919) 734-9455(919) 734-4769 Get Directions Write a Review

NPPES record last updated: February 24, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 24, 2022, Dec 28, 2018 (2 updates tracked since 2018).

About Open Water Medical, Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OPEN WATER MEDICAL, PA (NPI 1720550940) is a healthcare organization registered as a clinic/center in Goldsboro, North Carolina and active in the NPI registry since December 2018. The organization holds a CLIA Microscopy certificate valid through August 31, 2026 and lists Tisha Rae Smith, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1720550940
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameOPEN WATER MEDICAL, PA
Location Address1209 E ASH STGoldsboro, NC 27530-5103
Mailing Address1620c Live Oak StBeaufort, NC 28516-1583 · (252) 728-5737 · Fax (252) 728-5739
Phone(919) 734-9455
Fax(919) 734-4769
Organization SubpartNo
Authorized OfficialTisha Rae SmithPractice Manager · (252) 728-5737
Enumeration DateDecember 28, 2018
Last NPPES UpdateFebruary 24, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 24, 2022
✔ NPI 1720550940 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Also ListedFamily MedicineTaxonomy 207Q00000X
1209 E ASH ST, Goldsboro, NC 27530
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 34D0239917

Open Water Medical, PA · Goldsboro, NC
Active · expires Aug 31, 2026
CLIA Number34D0239917
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorKerry A. Willis
Laboratory Phone(919) 734-9455
Laboratory LocationOpen Water Medical, PA1209 E Ash Street, Goldsboro, NC 27530
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTINE EDDINS STALLINGS FNP
Nurse Practitioner (Family)
1209 E ASH ST
GOLDSBORO, NC 27530
Wayne County (919) 734-9455
DR. DAVIS WILLIAM TROY HOLT DC, MSN, FNP-BC
Nurse Practitioner (Family)
1209 E ASH ST
GOLDSBORO, NC 27530
Wayne County (919) 734-9455
DR. GEORGE MAYO, III
Dentist (Orthodontics and Dentofacial Orthopedics)
1209 E ASH ST
GOLDSBORO, NC 27530
Wayne County (919) 736-0304

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Open Water Medical, PA's NPI number?

The NPI number for Open Water Medical, PA is 1720550940. It was assigned to this organization in the NPPES registry on December 28, 2018.

Where is Open Water Medical, PA located?

Open Water Medical, PA is located at 1209 E Ash St, Goldsboro, NC 27530. The listed phone number is (919) 734-9455.

What is Open Water Medical, PA's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Open Water Medical, PA hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 34D0239917) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Open Water Medical, PA was last updated on February 24, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.