Provider Demographics
NPI:1184661050
Name:LENOIR MEMORIAL HOSPITAL, INCORPORATED
Entity Type:Organization
Organization Name:LENOIR MEMORIAL HOSPITAL, INCORPORATED
Other - Org Name:DOWN EAST MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-974-1183
Mailing Address - Street 1:2903 N HERRITAGE ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1581
Mailing Address - Country:US
Mailing Address - Phone:252-522-1761
Mailing Address - Fax:252-522-2815
Practice Address - Street 1:2903 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1581
Practice Address - Country:US
Practice Address - Phone:252-522-1761
Practice Address - Fax:252-522-2815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LENOIR MEMORIAL HOSPIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2305332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700270Medicaid
NC7700270Medicaid