Provider Demographics
NPI:1033475421
Name:CALDWELL MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:CALDWELL MEMORIAL HOSPITAL, INC
Other - Org Name:MCBURNEY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/COO/CNO
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-757-5100
Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5965
Mailing Address - Fax:828-757-5104
Practice Address - Street 1:109 FAIRWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2440
Practice Address - Country:US
Practice Address - Phone:828-728-0900
Practice Address - Fax:828-728-0868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-10
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC184Medicare PIN