Provider Demographics
NPI:1669008967
Name:NORTHERN HOSPITAL OF SURRY COUNTY
Entity Type:Organization
Organization Name:NORTHERN HOSPITAL OF SURRY COUNTY
Other - Org Name:NORTHERN REGIONAL HOSPITAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:HICKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-719-7102
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1101
Mailing Address - Country:US
Mailing Address - Phone:336-719-7134
Mailing Address - Fax:336-719-7199
Practice Address - Street 1:830 ROCKFORD ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5322
Practice Address - Country:US
Practice Address - Phone:336-719-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN HOSPITAL OF SURRY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-18
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory