Provider Demographics
NPI:1013056381
Name:DAYSPRING TRUST
Entity Type:Organization
Organization Name:DAYSPRING TRUST
Other - Org Name:DAYSPRING MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-492-2800
Mailing Address - Street 1:217 DAYSPRING WAY
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-8216
Mailing Address - Country:US
Mailing Address - Phone:336-492-2800
Mailing Address - Fax:336-492-2813
Practice Address - Street 1:217 DAYSPRING WAY
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-8216
Practice Address - Country:US
Practice Address - Phone:336-492-2800
Practice Address - Fax:336-492-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC66384OtherBCBS OF NC
NC8966384Medicaid
NC8966384Medicaid
209480CMedicare ID - Type Unspecified