Provider Demographics
NPI:1710072186
Name:UNION MEMORIAL REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:UNION MEMORIAL REGIONAL MEDICAL CENTER, INC
Other - Org Name:FRANKLIN STREET AMBULATORY CLINIC/FACILITY OF URMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:704-283-3185
Mailing Address - Street 1:412 E. FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111
Mailing Address - Country:US
Mailing Address - Phone:704-289-9461
Mailing Address - Fax:
Practice Address - Street 1:412 EAST FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28111
Practice Address - Country:US
Practice Address - Phone:704-289-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH 0050261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235115BOtherMEDICARE