Provider Demographics
NPI:1639407182
Name:HARRIS REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:HARRIS REGIONAL HOSPITAL INC
Other - Org Name:MOUNTAINCARE UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-7104
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-1052
Mailing Address - Country:US
Mailing Address - Phone:828-586-7820
Mailing Address - Fax:828-586-7821
Practice Address - Street 1:81 MEDICAL PARK LOOP STE 204
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5280
Practice Address - Country:US
Practice Address - Phone:828-586-7820
Practice Address - Fax:828-586-7821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS REGIONAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty