1588099022 NPI number — NORTHERN HOSPITAL OF SURRY COUNTY

Table of content: (NPI 1588099022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588099022 NPI number — NORTHERN HOSPITAL OF SURRY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN HOSPITAL 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:
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:
1588099022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2021
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:
336-719-7000
Provider Business Mailing Address Fax Number:
336-719-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 DUTCHMAN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28621-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-835-5330
Provider Business Practice Location Address Fax Number:
336-526-1399
Provider Enumeration Date:
09/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HODGIN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
V. PRESIDENT OF PATIENT SERVICES &
Authorized Official Telephone Number:
336-719-7019

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  11612 , 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: 2141874 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89132UV , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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