Provider Demographics
NPI:1750311452
Name:BLADEN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BLADEN COUNTY HOSPITAL
Other - Org Name:WOMENS HEALTH SPECIALIST FOR BLADEN COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-862-5179
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-0398
Mailing Address - Country:US
Mailing Address - Phone:910-862-6672
Mailing Address - Fax:910-862-6674
Practice Address - Street 1:300 EAST MCKAY STREET
Practice Address - Street 2:SUITE F
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337
Practice Address - Country:US
Practice Address - Phone:910-862-6672
Practice Address - Fax:910-862-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0154261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015XJOtherBCBS
NC89015XJMedicaid
NC015XJOtherBCBS