1962575860 NPI number — DAVIE MEDICAL CENTER

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 1962575860 NPI number — DAVIE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIE MEDICAL CENTER
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:
1962575860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 HOSPITAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCKSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27028-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-702-5500
Provider Business Mailing Address Fax Number:
336-702-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 NC HIGHWAY 801 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERMUDA RUN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27006-7905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-998-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT, DAVIE MEDICAL CENTER
Authorized Official Telephone Number:
336-713-4944

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC1029 , 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: 3409383 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3409627 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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