Provider Demographics
NPI:1780868406
Name:HARRIS REGIONAL HOSPITAL INC.
Entity Type:Organization
Organization Name:HARRIS REGIONAL HOSPITAL INC.
Other - Org Name:MOUNTAIN VALLEY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MS
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-586-7104
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0638
Mailing Address - Country:US
Mailing Address - Phone:828-586-7466
Mailing Address - Fax:828-586-4512
Practice Address - Street 1:37 MEDICAL PARK LOOP
Practice Address - Street 2:SUITE 103
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5289
Practice Address - Country:US
Practice Address - Phone:828-586-7466
Practice Address - Fax:828-586-4512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909013Medicaid
NCAPPLIED FORMedicare PIN
235016CMedicare PIN