Provider Demographics
NPI:1982636007
Name:CALDWELL MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CALDWELL MEMORIAL HOSPITAL
Other - Org Name:ALVIN DAUGHTRIDGE ARTHRITIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/ CFO/CCO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:828-757-5221
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-0710
Mailing Address - Country:US
Mailing Address - Phone:828-757-5070
Mailing Address - Fax:828-757-7882
Practice Address - Street 1:322 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5702
Practice Address - Country:US
Practice Address - Phone:828-757-6400
Practice Address - Fax:828-757-6424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALDWELL MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013CFOtherBCBS
NC89013CFMedicaid
NC89013CFMedicaid