Provider Demographics
NPI:1770636490
Name:BAPTIST HOSPITAL HOME RX
Entity type:Organization
Organization Name:BAPTIST HOSPITAL HOME RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-716-5220
Mailing Address - Street 1:PO BOX 602078
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2078
Mailing Address - Country:US
Mailing Address - Phone:336-713-8075
Mailing Address - Fax:336-713-8029
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-8075
Practice Address - Fax:336-713-8029
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH CAROLINA BAPTIST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704286Medicaid
VA010099331Medicaid
NC6800482Medicaid
VA010098874Medicaid
NC3439874OtherNCPDP
NC0347272Medicaid
NC3439874OtherNCPDP