1366449282 NPI number — NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY

Table of content: (NPI 1366449282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366449282 NPI number — NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
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:
NORTHERN REGIONAL 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:
1366449282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27030-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-719-7119
Provider Business Mailing Address Fax Number:
336-719-7467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
830 ROCKFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27030-5322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-719-7119
Provider Business Practice Location Address Fax Number:
336-719-7467
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HICKING
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
JONES
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
336-719-7102

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H0184 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336I0012X , with the licence number: 02362 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009810269 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: R103HOS . This is a "BLUE MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3409112 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5003269 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00396 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 000697 . This is a "ANTHEM - BCBS OF VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3400003 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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