Provider Demographics
NPI:1649235797
Name:PUNGO DISTRICT HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:PUNGO DISTRICT HOSPITAL CORPORATION
Other - Org Name:VIDANT PUNGO HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-944-2208
Mailing Address - Street 1:202 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1450
Mailing Address - Country:US
Mailing Address - Phone:252-943-2111
Mailing Address - Fax:252-944-2236
Practice Address - Street 1:202 E WATER ST
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-1450
Practice Address - Country:US
Practice Address - Phone:252-943-2111
Practice Address - Fax:252-944-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0002275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3451310Medicaid
NC34Z310Medicare ID - Type Unspecified