Provider Demographics
NPI:1972593051
Name:HOOTS MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:HOOTS MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-6776
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0068
Mailing Address - Country:US
Mailing Address - Phone:336-679-6776
Mailing Address - Fax:336-679-6716
Practice Address - Street 1:624 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7804
Practice Address - Country:US
Practice Address - Phone:336-679-6776
Practice Address - Fax:336-679-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0155282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401308Medicaid
NC700HOSOtherPARTNERS
NC00260OtherBCBS IP OP
NC341308Medicare Oscar/Certification
NC700HOSOtherPARTNERS
NC00260OtherBCBS IP OP
NC2352712Medicare PIN