Provider Demographics
NPI:1841241213
Name:THE PRESBYTERIAN HOSPITAL
Entity Type:Organization
Organization Name:THE PRESBYTERIAN HOSPITAL
Other - Org Name:NOVANT HEALTH HOSPICE & PALLIATIVE CARE A DEPARTMENT OF NOVANT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9735
Mailing Address - Street 1:2085 FRONTIS PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5614
Mailing Address - Country:US
Mailing Address - Phone:336-277-7226
Mailing Address - Fax:336-277-9795
Practice Address - Street 1:324 N MCDOWELL STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-384-6478
Practice Address - Fax:704-384-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS1445251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401575Medicaid
341575Medicare ID - Type Unspecified