Provider Demographics
NPI:1780653865
Name:PENDER MEMORIAL HOSPITAL, INCORPORATED
Entity Type:Organization
Organization Name:PENDER MEMORIAL HOSPITAL, INCORPORATED
Other - Org Name:PMH-SWING BEDS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-300-4004
Mailing Address - Street 1:507 E FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5131
Mailing Address - Country:US
Mailing Address - Phone:910-300-4000
Mailing Address - Fax:
Practice Address - Street 1:507 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5131
Practice Address - Country:US
Practice Address - Phone:910-300-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENDER MEMORIAL HOSPITAL, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0115275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3450093Medicaid
NC3450093Medicaid
NC34Z307Medicare Oscar/Certification