Provider Demographics
NPI:1942521976
Name:LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LORIS COMMUNITY HOSPITAL DISTRICT
Other - Org Name:SUNSET BEACH INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LORIS PHYSICIAN CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-880-6406
Mailing Address - Street 1:1733 SEASIDE RD SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5849
Mailing Address - Country:US
Mailing Address - Phone:910-575-8488
Mailing Address - Fax:910-575-6542
Practice Address - Street 1:1733 SEASIDE RD SW
Practice Address - Street 2:SUITE B
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-5849
Practice Address - Country:US
Practice Address - Phone:910-575-8488
Practice Address - Fax:910-575-6542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LORIS COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-14
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC201015300336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty