Provider Demographics
NPI:1700889557
Name:PINEHURST NEPHROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:PINEHURST NEPHROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOEHN-SARIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-295-3344
Mailing Address - Street 1:293 OLMSTED BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9191
Mailing Address - Country:US
Mailing Address - Phone:910-295-3344
Mailing Address - Fax:910-295-3165
Practice Address - Street 1:293 OLMSTED BLVD STE 7
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9191
Practice Address - Country:US
Practice Address - Phone:910-295-3344
Practice Address - Fax:910-295-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700591207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890249KMedicaid
NC890249KMedicaid