1861543852 NPI number — CENTRAL REGIONAL HOSPITAL

Table of content: (NPI 1861543852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861543852 NPI number — CENTRAL REGIONAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL REGIONAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL REGIONAL HOSPITAL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861543852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/23/2008
NPI Reactivation Date:
09/16/2009

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CENTRAL BILLING OFFICES DHHS OFC
Provider Second Line Business Mailing Address:
2021 MAIL SERVICE CTR
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27699-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-733-9867
Provider Business Mailing Address Fax Number:
919-733-1512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 VEAZEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27509-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-764-5700
Provider Business Practice Location Address Fax Number:
919-764-5720
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PECKMAN
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
919-764-5704

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336L0003X , with the licence number: 10092 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2065391 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3404004 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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