Provider Demographics
NPI:1689976912
Name:ANGEL MEDICAL CENTER,INC.
Entity Type:Organization
Organization Name:ANGEL MEDICAL CENTER,INC.
Other - Org Name:ANGEL PHYSICIAN PRACATICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-369-4220
Mailing Address - Street 1:120 RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-2612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 MEDICAL PARK DR
Practice Address - Street 2:STE 201
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-2632
Practice Address - Country:US
Practice Address - Phone:828-349-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914894Medicaid