Provider Demographics
NPI:1245211168
Name:SENTARA ALBEMARLE REGIONAL MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:SENTARA ALBEMARLE REGIONAL MEDICAL CENTER LLC
Other - Org Name:SENTARA ALBEMARLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-7020
Mailing Address - Street 1:1144 N ROAD STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-384-4600
Mailing Address - Fax:252-384-4677
Practice Address - Street 1:1144 N ROAD STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-384-4600
Practice Address - Fax:252-384-4677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0054282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014TKOtherBLUE CROSS
NC00009OtherBLUE CROSS
NC07734OtherBLUE CROSS
VA9844397Medicaid
NC89014PGMedicaid
NC3400109Medicaid
NC89014PGMedicaid
NC2352735Medicare PIN