Provider Demographics
NPI:1851423552
Name:UNION MEMORIAL REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:UNION MEMORIAL REGIONAL MEDICAL CENTER, INC
Other - Org Name:CMC - UNION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:704-283-3185
Mailing Address - Street 1:600 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-6000
Mailing Address - Country:US
Mailing Address - Phone:704-286-3185
Mailing Address - Fax:704-226-5800
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-6000
Practice Address - Country:US
Practice Address - Phone:704-286-3185
Practice Address - Fax:704-226-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34-24126OtherNABP NUMBER
NC0905141Medicaid
NC06001OtherNC BOARD OF PHARMACY
NC06001OtherNC BOARD OF PHARMACY