Provider Demographics
NPI:1689944357
Name:HARRIS REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:HARRIS REGIONAL HOSPITAL, INC
Other - Org Name:MOUNTAIN REGIONAL OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-7100
Mailing Address - Street 1:98 DOCTORS DR
Mailing Address - Street 2:STE 320
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-4501
Mailing Address - Country:US
Mailing Address - Phone:828-631-8913
Mailing Address - Fax:828-586-7904
Practice Address - Street 1:98 DOCTORS DR
Practice Address - Street 2:STE 320
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-4501
Practice Address - Country:US
Practice Address - Phone:828-631-8913
Practice Address - Fax:828-586-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919213Medicaid
NC5919213Medicaid