1265466452 NPI number — FLETCHER HOSPITAL INC.

Table of content: (NPI 1265466452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265466452 NPI number — FLETCHER HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLETCHER 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:
PARK RIDGE HEALTH, PARK RIDGE HOSPITAL
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:
1265466452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 948117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30394-8117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-687-5616
Provider Business Mailing Address Fax Number:
828-650-8076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28792-5272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-684-8501
Provider Business Practice Location Address Fax Number:
828-687-5298
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURROUGHS
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
828-681-2102

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  H0019 , 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: 235091G . This is a "MEDICARE PROFESSIONAL FEE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 340023 . This is a "UNICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5070367 . This is a "UNITED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6380360 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 387 . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400023S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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