Provider Demographics
NPI:1033350186
Name:DUKE UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:DUKE UNIVERSITY MEDICAL CENTER
Other - Org Name:DURHAM COMMUNITY HEALTH NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CARE MGMT & CLINICAL SERV
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:919-681-4220
Mailing Address - Street 1:PO BOX 104425
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-3071
Mailing Address - Fax:919-613-6899
Practice Address - Street 1:411 W CHAPEL HILL ST
Practice Address - Street 2:3RD FLOOR, SUITE 310
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3616
Practice Address - Country:US
Practice Address - Phone:919-681-3071
Practice Address - Fax:919-613-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408197OtherPROVIDER NUMBER