Provider Demographics
NPI:1780853937
Name:HOOTS MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:HOOTS MEMORIAL HOSPITAL INC
Other - Org Name:HOOTS MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-6776
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0068
Mailing Address - Country:US
Mailing Address - Phone:336-679-6776
Mailing Address - Fax:336-679-6716
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7804
Practice Address - Country:US
Practice Address - Phone:336-679-6776
Practice Address - Fax:336-679-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012JYOtherBCBSNC
NC89012JYMedicaid
NC2352712CMedicare PIN