Provider Demographics
NPI:1205002789
Name:BLADEN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BLADEN HEALTHCARE, LLC
Other - Org Name:CAPE FEAR VALLEY - BLADEN COUNTY HOSPITAL (EMERGENCY DEPARTMENT)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP MANAGED CARE AND REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-615-5572
Mailing Address - Street 1:501 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-9375
Mailing Address - Country:US
Mailing Address - Phone:910-862-5179
Mailing Address - Fax:910-862-5129
Practice Address - Street 1:501 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9375
Practice Address - Country:US
Practice Address - Phone:910-862-5179
Practice Address - Fax:910-862-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0154261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890766MMedicaid
NC235012Medicare PIN