Provider Demographics
NPI:1851532089
Name:HARRIS REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:HARRIS REGIONAL HOSPITAL INC
Other - Org Name:WNC PEDIATRIC AND ADOLESCENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
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 247
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0247
Mailing Address - Country:US
Mailing Address - Phone:828-586-9642
Mailing Address - Fax:828-586-9673
Practice Address - Street 1:98 DOCTORS DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5195
Practice Address - Country:US
Practice Address - Phone:828-586-9642
Practice Address - Fax:828-586-9673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRIS REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-18
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911303Medicaid