Provider Demographics
NPI:1477619351
Name:BROUGHTON HOSPITAL
Entity Type:Organization
Organization Name:BROUGHTON HOSPITAL
Other - Org Name:BROUGHTON HOSPITAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STREATER
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARM
Authorized Official - Phone:828-433-2325
Mailing Address - Street 1:CENTRAL BILLING OFFICE DHHS CONTROLLERS OFC
Mailing Address - Street 2:2021 MAIL SERVICE CENTER
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-0001
Mailing Address - Country:US
Mailing Address - Phone:919-733-9867
Mailing Address - Fax:919-733-1512
Practice Address - Street 1:1000 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3938
Practice Address - Country:US
Practice Address - Phone:828-433-2509
Practice Address - Fax:828-433-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
NC026013336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066474OtherPK
NC340-4025Medicaid