Provider Demographics
NPI:1790062362
Name:CATAWBA VALLEY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:CATAWBA VALLEY MEDICAL GROUP, INC
Other - Org Name:CATAWBA VALLEY FAMILY CARE - CATAWBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-326-3809
Mailing Address - Street 1:200 ROSENWALD SCHOOL ST SW
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:NC
Mailing Address - Zip Code:28609-8896
Mailing Address - Country:US
Mailing Address - Phone:828-241-2377
Mailing Address - Fax:828-241-2678
Practice Address - Street 1:200 ROSENWALD SCHOOL ST SW
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:NC
Practice Address - Zip Code:28609-8896
Practice Address - Country:US
Practice Address - Phone:828-241-2377
Practice Address - Fax:828-241-2678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATAWBA VALLEY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-10
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC026CPOtherNC BCBS
NC1790062362Medicaid
NC00A968Medicare Oscar/Certification