1144461674 NPI number — UNIVERSAL HEALTH CARE ROCKY MOUNT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144461674 NPI number — UNIVERSAL HEALTH CARE ROCKY MOUNT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSAL HEALTH CARE ROCKY MOUNT, INC.
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:
Provider Other Organization Name Type Code:
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:
1144461674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 10TH ST NW STE B-2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONOVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28613-2419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-464-1817
Provider Business Mailing Address Fax Number:
828-464-8137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 RALEIGH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27803-3729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-442-4156
Provider Business Practice Location Address Fax Number:
252-407-8478
Provider Enumeration Date:
03/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
SUTTON
Authorized Official Title or Position:
A/R DIRECTOR
Authorized Official Telephone Number:
828-464-1817

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7803186 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3426090 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3425137 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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