Provider Demographics
NPI:1568869089
Name:SURRY REGIONAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SURRY REGIONAL HEALTH SERVICES, INC.
Other - Org Name:DBA: NORTHERN MEDICAL GROUP PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SURRY REGIONAL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHULZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-783-8353
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4522
Mailing Address - Fax:336-786-3752
Practice Address - Street 1:314 S SOUTH ST
Practice Address - Street 2:SUITE 800
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4491
Practice Address - Country:US
Practice Address - Phone:336-786-4522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty