Provider Demographics
NPI:1720148414
Name:STOVALL MEDICAL CENTER
Entity Type:Organization
Organization Name:STOVALL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-690-8880
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:STOVALL
Mailing Address - State:NC
Mailing Address - Zip Code:27582-0027
Mailing Address - Country:US
Mailing Address - Phone:919-690-8880
Mailing Address - Fax:919-690-8882
Practice Address - Street 1:100 DURHAM ST.
Practice Address - Street 2:
Practice Address - City:STOVALL
Practice Address - State:NC
Practice Address - Zip Code:27582
Practice Address - Country:US
Practice Address - Phone:919-690-8880
Practice Address - Fax:919-690-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906025Medicaid
NC5821143OtherCIGNA
NC018XGOtherBCBS
NC230032Medicare PIN
NC018XGOtherBCBS