Provider Demographics
NPI:1578854147
Name:HOSPICE OF SURRY COUNTY, INC
Entity Type:Organization
Organization Name:HOSPICE OF SURRY COUNTY, INC
Other - Org Name:MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:336-789-2922
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0325
Mailing Address - Country:US
Mailing Address - Phone:336-789-2922
Mailing Address - Fax:336-789-0856
Practice Address - Street 1:105 N CRUTCHFIELD ST UNIT 2
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8804
Practice Address - Country:US
Practice Address - Phone:336-789-2922
Practice Address - Fax:336-789-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020TJOtherBCBS