Provider Demographics
NPI:1457332702
Name:MOREHEAD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MOREHEAD MEMORIAL HOSPITAL
Other - Org Name:PIEDMONT SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-9711
Mailing Address - Street 1:515 THOMPSON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5068
Mailing Address - Country:US
Mailing Address - Phone:336-623-9118
Mailing Address - Fax:336-623-1902
Practice Address - Street 1:515 THOMPSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5068
Practice Address - Country:US
Practice Address - Phone:336-623-9118
Practice Address - Fax:336-623-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01563OtherBLUE CROSS BLUE SHIELD NC
VA026870OtherANTHEM
NC7901563Medicaid
NCCD8709OtherRAILROAD MEDICARE
VA026870OtherANTHEM