Provider Demographics
NPI:1316045263
Name:ROCKY MOUNT GYNECOLOGY AND WOMEN'S HEALTH, PA
Entity Type:Organization
Organization Name:ROCKY MOUNT GYNECOLOGY AND WOMEN'S HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-443-6622
Mailing Address - Street 1:132 FOY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2417
Mailing Address - Country:US
Mailing Address - Phone:252-443-6622
Mailing Address - Fax:252-443-6404
Practice Address - Street 1:132 FOY DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2417
Practice Address - Country:US
Practice Address - Phone:252-443-6622
Practice Address - Fax:252-443-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02558OtherBLUE CROSS BLUE SHIELD
NC8902558Medicaid
NCCC9858OtherMEDICARE RAILROAD
NC0419Medicare PIN