Provider Demographics
NPI:1255507737
Name:BLADEN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:BLADEN HEALTHCARE, LLC
Other - Org Name:CAPE FEAR VALLEY BMA ELIZABETHTOWN
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 1:300-A EAST MCKAY STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337
Mailing Address - Country:US
Mailing Address - Phone:910-862-6308
Mailing Address - Fax:910-862-5501
Practice Address - Street 1:300A E MCKAY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9037
Practice Address - Country:US
Practice Address - Phone:910-862-5500
Practice Address - Fax:910-862-5501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
NCH0154261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34-3966AMedicaid
NC2351500Medicare PIN
NC34-3966AMedicaid