Provider Demographics
NPI:1366449282
Name:NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Entity Type:Organization
Organization Name:NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Other - Org Name:NORTHERN REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:HICKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-719-7102
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1101
Mailing Address - Country:US
Mailing Address - Phone:336-719-7119
Mailing Address - Fax:336-719-7467
Practice Address - Street 1:830 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5322
Practice Address - Country:US
Practice Address - Phone:336-719-7119
Practice Address - Fax:336-719-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0184282N00000X
3336C0003X, 3336L0003X
NC023623336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009810269Medicaid
R103HOSOtherBLUE MEDICARE
3409112OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5003269OtherUNITED HEALTH CARE
NC00396OtherBCBS OF NC
000697OtherANTHEM - BCBS OF VA
NC3400003Medicaid
NC340003Medicare Oscar/Certification