Provider Demographics
NPI:1265898829
Name:SURRY REGIONAL HEALTH SERVICES INC, DBA NORTHERN MEDICAL GROUP FAMILY
Entity type:Organization
Organization Name:SURRY REGIONAL HEALTH SERVICES INC, DBA NORTHERN MEDICAL GROUP FAMILY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-786-3400
Mailing Address - Street 1:280 N POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4133
Mailing Address - Fax:336-783-3417
Practice Address - Street 1:280 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2267
Practice Address - Country:US
Practice Address - Phone:336-786-4133
Practice Address - Fax:336-783-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901632305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1831392174OtherNPI
NC5913496Medicaid