Provider Demographics
NPI:1174829204
Name:MOREHEAD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MOREHEAD MEMORIAL HOSPITAL
Other - Org Name:MOREHEAD UROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-9711
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27289-0488
Mailing Address - Country:US
Mailing Address - Phone:336-635-6804
Mailing Address - Fax:336-627-0778
Practice Address - Street 1:618 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5863
Practice Address - Country:US
Practice Address - Phone:336-635-6804
Practice Address - Fax:336-627-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty