1417941352 NPI number — SCOTLAND MEMORIAL HOSPITAL, INC

Table of content: (NPI 1417941352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417941352 NPI number — SCOTLAND MEMORIAL HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTLAND 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:
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:
1417941352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 604093
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:
28260-4093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-291-7000
Provider Business Mailing Address Fax Number:
910-844-5840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 W. MARTIN LUTHER KING JR. DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAXTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-844-4077
Provider Business Practice Location Address Fax Number:
910-844-5840
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STONGE
Authorized Official First Name:
LUCIEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
910-291-7547

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 34-3987 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0262L . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NPA922 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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