Provider Demographics
NPI:1598761058
Name:HARNETT HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:HARNETT HEALTH SYSTEM INC
Other - Org Name:BETSY JOHNSON REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:910-892-1000
Mailing Address - Street 1:PO BOX 600078
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27675-6078
Mailing Address - Country:US
Mailing Address - Phone:910-892-1000
Mailing Address - Fax:910-891-6032
Practice Address - Street 1:800 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5510
Practice Address - Country:US
Practice Address - Phone:910-892-1000
Practice Address - Fax:910-891-6032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARNETT HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0224207Q00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2351443COtherMEDICARE - PROFEE GROUP #
NC07683OtherBCBS PROFESSIONAL
NC8907683OtherMEDICAID-PROFEE GROUP #
NC8907683OtherMEDICAID-PROFEE GROUP #