Provider Demographics
NPI:1346658531
Name:CALDWELL MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:CALDWELL MEMORIAL HOSPITAL, INC
Other - Org Name:FOOTHILLS DIALYSIS ACCESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-757-5100
Mailing Address - Street 1:321 MULBERRY ST SW
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5720
Mailing Address - Country:US
Mailing Address - Phone:828-757-5965
Mailing Address - Fax:828-757-5104
Practice Address - Street 1:1031 MORGANTON BLVD SW
Practice Address - Street 2:SUITE C
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5677
Practice Address - Country:US
Practice Address - Phone:828-757-8240
Practice Address - Fax:828-757-8241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-31
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0061208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02A8XOtherBCBS
NCD996Medicare PIN