Provider Demographics
NPI:1497045652
Name:PITT COUNTY MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:PITT COUNTY MEMORIAL HOSPITAL INC
Other - Org Name:VIDANT RADIOSURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-847-4582
Mailing Address - Street 1:PO BOX 6028
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-6028
Mailing Address - Country:US
Mailing Address - Phone:252-847-4700
Mailing Address - Fax:252-847-4725
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-847-4700
Practice Address - Fax:252-847-4725
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PITT COUNTY MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-08
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0037FOtherBCBS
NC5918805Medicaid
NC0037FOtherBCBS