Provider Demographics
NPI:1669535977
Name:THE PRESBYTERIAN HOSPITAL
Entity type:Organization
Organization Name:THE PRESBYTERIAN HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:MCDOWELL
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-384-5184
Mailing Address - Street 1:2085 FRONTIS PLAZA BLVD
Mailing Address - Street 2:2ND FLOOR BD&S
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5614
Mailing Address - Country:US
Mailing Address - Phone:336-277-1149
Mailing Address - Fax:336-277-7675
Practice Address - Street 1:1901 RANDOLPH RD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-316-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PRESBYTERIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
562090263OtherTRICARE
07626OtherBCBS
562090263OtherTRICARE