Provider Demographics
NPI:1508034810
Name:WASHINGTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HOSPITAL
Other - Org Name:PLYMOUTH PRIMARY CARE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-793-7653
Mailing Address - Street 1:958 US HIGHWAY 64 E
Mailing Address - Street 2:PO BOX 707
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9216
Mailing Address - Country:US
Mailing Address - Phone:252-793-4135
Mailing Address - Fax:252-793-1530
Practice Address - Street 1:1006 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9215
Practice Address - Country:US
Practice Address - Phone:252-793-7701
Practice Address - Fax:252-793-7736
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-20
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0006207Q00000X, 207R00000X, 208M00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235121AMedicare Oscar/Certification