Provider Demographics
NPI:1043759335
Name:BLADEN HEALTHCARE LLC
Entity Type:Organization
Organization Name:BLADEN HEALTHCARE LLC
Other - Org Name:CAPE FEAR VALLEY BMA CLARKTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CORP REVENUE AND MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-615-5572
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9858 WR LATHAN DR
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-9255
Practice Address - Country:US
Practice Address - Phone:910-647-1503
Practice Address - Fax:910-647-1505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND COUNTY HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-20
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health