1922161199 NPI number — MOREHEAD MEMORIAL HOSPITAL

Table of content: KYLIE M LATE (NPI 1205422409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922161199 NPI number — MOREHEAD MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOREHEAD MEMORIAL 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:
Provider Other Organization Name Type Code:
6
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:
1922161199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
518 S. VAN BUREN ROAD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
EDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27288-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-623-1560
Provider Business Mailing Address Fax Number:
336-623-2742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 S. VAN BUREN ROAD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27288-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-623-1560
Provider Business Practice Location Address Fax Number:
336-623-2742
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUNT
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VP OF PRACTICE MANAGEMENT
Authorized Official Telephone Number:
336-623-9711

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  30224 , 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: 8971024 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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