Provider Demographics
NPI:1053444901
Name:PENDER MEMORIAL HOSPITAL INCORPORATED
Entity Type:Organization
Organization Name:PENDER MEMORIAL HOSPITAL INCORPORATED
Other - Org Name:PENDER MEMORIAL HOSPITAL ANESTHESIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-300-4004
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:910-259-7136
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:910-259-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0115282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000199Medicaid
NC235092CMedicare ID - Type UnspecifiedANESTHESIA PROVIDER #