Provider Demographics
NPI:1154326379
Name:DAVIE MEDICAL CENTER
Entity Type:Organization
Organization Name:DAVIE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE - AFFILIATES, OPER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-716-3019
Mailing Address - Street 1:329 NC HIGHWAY 801 N
Mailing Address - Street 2:
Mailing Address - City:BERMUDA RUN
Mailing Address - State:NC
Mailing Address - Zip Code:27006-7905
Mailing Address - Country:US
Mailing Address - Phone:336-751-8100
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:329 NC HIGHWAY 801 N
Practice Address - Street 2:
Practice Address - City:BERMUDA RUN
Practice Address - State:NC
Practice Address - Zip Code:27006-7905
Practice Address - Country:US
Practice Address - Phone:336-998-1300
Practice Address - Fax:336-702-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
NCH0171282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401313Medicaid
NC34-U187OtherMEDICARE SNF
NC00085OtherBLUECROSS/BLUESHIELD
NC34-1313OtherMEDICARE CRITICAL ACCESS # ACTIVE UNTIL 12/31/2013
NC34-0187Medicare PIN