Provider Demographics
NPI:1497708838
Name:THE PRESBYTERIAN HOSPITAL
Entity Type:Organization
Organization Name:THE PRESBYTERIAN HOSPITAL
Other - Org Name:PRESBYTERIAN BEHAVIORAL HEALTH UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9656
Mailing Address - Street 1:2085 FRONTIS PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5614
Mailing Address - Country:US
Mailing Address - Phone:336-277-7226
Mailing Address - Fax:336-277-9795
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PRESBYTERIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC273R00000X, 282N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
34S053Medicare ID - Type Unspecified