1558812594 NPI number — ST. LUKE'S HOSPITAL INC

Table of content: HOLLIE DESSELLE PRYOR LPC (NPI 1699820290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558812594 NPI number — ST. LUKE'S HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. LUKE'S 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:
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:
1558812594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28722-6418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-894-3311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28722-6418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-894-3311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BROSS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
BEVERLY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
828-894-0869

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  H0079 , 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: 1144419052 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1427191477 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427191477 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1427191477 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497944912 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760526586 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1245373455 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1316136328 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1760526586 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1245373455 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1245373455 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306035829 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497944912 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1306035829 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760526586 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871776914 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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