Provider Demographics
NPI:1679588420
Name:CALDWELL MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:CALDWELL MEMORIAL HOSPITAL, INC.
Other - Org Name:CALDWELL FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/ CFO/CCO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-757-5221
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5070
Mailing Address - Fax:828-757-5939
Practice Address - Street 1:212 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5414
Practice Address - Country:US
Practice Address - Phone:828-759-4900
Practice Address - Fax:828-754-6833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCC2061OtherRR MEDICARE
NC0117YOtherBCBS
NC890117YMedicaid
NC890117YMedicaid