1053444901 NPI number — PENDER MEMORIAL HOSPITAL INCORPORATED

Table of content: (NPI 1053444901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053444901 NPI number — PENDER MEMORIAL HOSPITAL INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENDER MEMORIAL HOSPITAL INCORPORATED
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:
1053444901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 604271
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-4271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-8757
Provider Business Mailing Address Fax Number:
336-718-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 E FREMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURGAW
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28425-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-259-5451
Provider Business Practice Location Address Fax Number:
910-259-7136
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GLASER
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT & COO
Authorized Official Telephone Number:
910-300-4004

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  H0115 , 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: 8000199 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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