Provider Demographics
NPI:1326325994
Name:CATAWBA VALLEY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CATAWBA VALLEY MEDICAL GROUP, INC
Other - Org Name:CATAWBA VALLEY FAMILY MEDICINE-SOUTH EAST CATAWBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-326-3800
Mailing Address - Street 1:3900 TERRELL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-9509
Mailing Address - Country:US
Mailing Address - Phone:828-732-5450
Mailing Address - Fax:828-732-5451
Practice Address - Street 1:3900 TERRELL PARK DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673-9413
Practice Address - Country:US
Practice Address - Phone:828-732-5450
Practice Address - Fax:828-732-5451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATAWBA VALLEY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-10
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326325994Medicaid
NC026COOtherNC BCBS
NC1326325994Medicaid