Provider Demographics
NPI:1629170147
Name:MOREHEAD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MOREHEAD MEMORIAL HOSPITAL
Other - Org Name:FAMILY PRACTICE OF EDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-623-9711
Mailing Address - Street 1:515 THOMPSON ST
Mailing Address - Street 2:#D
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5068
Mailing Address - Country:US
Mailing Address - Phone:336-627-5178
Mailing Address - Fax:
Practice Address - Street 1:515 THOMPSON ST
Practice Address - Street 2:#D
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5068
Practice Address - Country:US
Practice Address - Phone:336-627-5178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0129XOtherBLUE CROSS
NC235082GOtherMEDICARE GRP PIN
NC890129XOtherMEDICAID GROUP # TERMINATED 3/1/09
NC5950636OtherMEDICAID GROUP # - EFFECTIVE 1/1/09
NC235082GOtherMEDICARE GRP PIN
NC5950636OtherMEDICAID GROUP # - EFFECTIVE 1/1/09