Provider Demographics
NPI:1023030756
Name:PENDER MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:PENDER MEMORIAL HOSPITAL INC.
Other - Org Name:PENDER MEMORIAL HOSPITAL SWING BED
Other - Org Type:Other Name
Authorized Official - Title/Position:INTRIM CEO OF HOSPITAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-259-5451
Mailing Address - Street 1:507 E FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5131
Mailing Address - Country:US
Mailing Address - Phone:910-259-5451
Mailing Address - Fax:
Practice Address - Street 1:507 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5131
Practice Address - Country:US
Practice Address - Phone:910-259-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0115275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34Z307Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER