1902988801 NPI number — STOKES REYNOLDS MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1902988801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902988801 NPI number — STOKES REYNOLDS MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOKES REYNOLDS MEMORIAL HOSPITAL, 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:
J R JONES 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:
1902988801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1570 NC 8 AND HWY 89 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANBURY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27021-7360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-593-2831
Provider Business Mailing Address Fax Number:
336-593-5350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 WEST KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-0402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-593-2831
Provider Business Practice Location Address Fax Number:
336-593-5350
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TILLMAN
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
336-593-5314

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X , with the licence number:  HO165 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7907741 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5950016 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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