1801823349 NPI number — DLP FRYE REGIONAL MEDICAL CENTER LLC

Table of content: (NPI 1801823349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801823349 NPI number — DLP FRYE REGIONAL MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DLP FRYE REGIONAL MEDICAL CENTER LLC
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:
FRYE REGIONAL MEDICAL CENTER
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:
1801823349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 SEVEN SPRINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7000
Provider Business Mailing Address Fax Number:
615-920-8913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 N CENTER ST
Provider Second Line Business Practice Location Address:
STE 20
Provider Business Practice Location Address City Name:
HICKORY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28601-5046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-315-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DILLON
Authorized Official First Name:
TERRANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
502-596-7220

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H0053 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 284300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00462 . This is a "BCBS OF NORTH CAROLINA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019734607 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340116B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 15110 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 902733500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP32874 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00109634Z , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3400116 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56-0852342 . This is a "CATHOLIC HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 229525300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3401162 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 368769590 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01407106 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0734412 . This is a "CIGNA (US / PUERTO RICO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000-95855 . This is a "PACIFICARE OF TEXAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0340116 . This is a "TENNCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3405327 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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