Provider Demographics
NPI:1346302429
Name:WEST CALDWELL HEALTH COUNCIL, INC.
Entity Type:Organization
Organization Name:WEST CALDWELL HEALTH COUNCIL, INC.
Other - Org Name:COLLETTSVILLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:MCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-754-2409
Mailing Address - Street 1:4330 COLLETTSVILLE RD
Mailing Address - Street 2:PO DRAWER 9
Mailing Address - City:COLLETTSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28611-9000
Mailing Address - Country:US
Mailing Address - Phone:828-754-2409
Mailing Address - Fax:828-754-2418
Practice Address - Street 1:4330 COLLETTSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLLETTSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28611-9000
Practice Address - Country:US
Practice Address - Phone:828-754-2409
Practice Address - Fax:828-754-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344038Medicaid
NC2343321Medicare UPIN
NC34-1947Medicare PIN