1689786717 NPI number — CUMBERLAND COUNTY HOSPITAL SYSTEM INC

Table of content: (NPI 1689786717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689786717 NPI number — CUMBERLAND COUNTY HOSPITAL SYSTEM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND COUNTY HOSPITAL SYSTEM 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:
1689786717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40908
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28309-0908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-615-6949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 GILLESPIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28306-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-678-7647
Provider Business Practice Location Address Fax Number:
910-609-5365
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISER
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
VP CORP REVENUE CYCLE/MANAGED CARE
Authorized Official Telephone Number:
910-615-5572

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1067 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 1067 , 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: 3406734 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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