Provider Demographics
NPI:1336189760
Name:JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:JOHNSTON FAMILY CARE CENTER-KENLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7128
Mailing Address - Street 1:509 N BRIGHTLEAF BLVD
Mailing Address - Street 2:P.O. BOX 1376
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-934-8171
Mailing Address - Fax:919-989-7297
Practice Address - Street 1:400 N ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542-9290
Practice Address - Country:US
Practice Address - Phone:919-284-4149
Practice Address - Fax:919-284-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
343409Medicare ID - Type Unspecified