Provider Demographics
NPI:1982018941
Name:SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC
Other - Org Name:SENTARA KITTY HAWK ADVANCED IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-455-7020
Mailing Address - Street 1:5200 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3990
Mailing Address - Country:US
Mailing Address - Phone:252-255-6040
Mailing Address - Fax:
Practice Address - Street 1:5200 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3990
Practice Address - Country:US
Practice Address - Phone:252-255-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENTARA HOSPITALS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-18
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ473480001Medicare Oscar/Certification