Provider Demographics
NPI:1114192358
Name:NORTH CAROLINA BAPTIST HOSPITAL
Entity Type:Organization
Organization Name:NORTH CAROLINA BAPTIST HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, BCPS
Authorized Official - Phone:336-713-3421
Mailing Address - Street 1:NC BAPTIST HOSPITAL SPECIALTY RX
Mailing Address - Street 2:PO BOX 602078
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2078
Mailing Address - Country:US
Mailing Address - Phone:336-713-8064
Mailing Address - Fax:336-713-7783
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:NORTH TOWER GROUND FLOOR
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-7776
Practice Address - Fax:336-713-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17329332B00000X
333600000X, 3336H0001X, 3336C0004X, 3336H0001X, 3336I0012X, 3336M0002X
NC100393336C0003X
VA02140018683336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0347707Medicaid
2067274OtherPK
2067274OtherPK
3626820001Medicare NSC
NC0347707Medicaid