Provider Demographics
NPI:1063472116
Name:ENGELHARD MEDICAL CENTER
Entity Type:Organization
Organization Name:ENGELHARD MEDICAL CENTER
Other - Org Name:ENGELHARD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-925-0058
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ENGELHARD
Mailing Address - State:NC
Mailing Address - Zip Code:27824-0277
Mailing Address - Country:US
Mailing Address - Phone:252-925-7000
Mailing Address - Fax:252-925-7700
Practice Address - Street 1:33270 US 264
Practice Address - Street 2:
Practice Address - City:ENGELHARD
Practice Address - State:NC
Practice Address - Zip Code:27824-0277
Practice Address - Country:US
Practice Address - Phone:252-925-7000
Practice Address - Fax:252-925-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017N7OtherBCBS NC
NC56162OtherMEDCOST
NC5913132Medicaid
NC56162OtherMEDCOST
NC2347345Medicare ID - Type Unspecified