Provider Demographics
NPI:1922282789
Name:STOKES REYNOLDS MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:STOKES REYNOLDS MEMORIAL HOSPITAL, INC.
Other - Org Name:STOKES MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-593-5314
Mailing Address - Street 1:1570 NC 8 AND HWY 89 N
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-7360
Mailing Address - Country:US
Mailing Address - Phone:336-593-2831
Mailing Address - Fax:336-593-5350
Practice Address - Street 1:1020 HOSPICE DR.
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:NC
Practice Address - Zip Code:27016
Practice Address - Country:US
Practice Address - Phone:336-593-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0165261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905757Medicaid
1922282789OtherBCBS
1922282789OtherBCBS