1437246204 NPI number — PAMLICO REGIONAL MEDICAL CENTER PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437246204 NPI number — PAMLICO REGIONAL MEDICAL CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMLICO REGIONAL MEDICAL CENTER PA
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:
1437246204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28515-0729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-745-3191
Provider Business Mailing Address Fax Number:
252-745-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-745-3191
Provider Business Practice Location Address Fax Number:
252-745-7385
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN JR
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
252-745-3191

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , 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: 8902364 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02364 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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