Provider Demographics
NPI:1609942820
Name:BOOMER MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BOOMER MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:NEWMAN
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-921-2273
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:156 BOOMER COMMUNITY CENTER RD
Mailing Address - City:BOOMER
Mailing Address - State:NC
Mailing Address - Zip Code:28606-9199
Mailing Address - Country:US
Mailing Address - Phone:336-921-2273
Mailing Address - Fax:336-921-2405
Practice Address - Street 1:156 BOOMER COMMUNITY CENTER RD
Practice Address - Street 2:
Practice Address - City:BOOMER
Practice Address - State:NC
Practice Address - Zip Code:28606-9199
Practice Address - Country:US
Practice Address - Phone:336-921-2273
Practice Address - Fax:336-921-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343930AMedicaid
NC343930AMedicaid