Provider Demographics
NPI:1831300870
Name:PENDER MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:PENDER MEMORIAL HOSPITAL, INC.
Other - Org Name:PENDER DIAGNOSTIC AND IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SITE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-259-5451
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:910-259-5451
Mailing Address - Fax:
Practice Address - Street 1:7910 US HWY 117
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457
Practice Address - Country:US
Practice Address - Phone:910-259-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH01152085R0202X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation