Provider Demographics
NPI:1346301421
Name:HAMLET HMA INC
Entity Type:Organization
Organization Name:HAMLET HMA INC
Other - Org Name:SANDHILLS REGIONAL MEDICAL CENTER-CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-205-8104
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-1109
Mailing Address - Country:US
Mailing Address - Phone:910-205-8000
Mailing Address - Fax:910-205-8007
Practice Address - Street 1:1000 W HAMLET AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4522
Practice Address - Country:US
Practice Address - Phone:910-205-8000
Practice Address - Fax:910-205-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000284Medicaid
NC260485Medicare ID - Type UnspecifiedCRNA MEDICARE PART B G#