Basic Information
| Provider Information | |||||||||
| NPI: | 1336189760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHNSTON MEMORIAL HOSPITAL AUTHORITY | ||||||||
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| OtherOrganizationName: | JOHNSTON FAMILY CARE CENTER-KENLY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 N BRIGHTLEAF BLVD | ||||||||
| Address2: | P.O. BOX 1376 | ||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199348171 | ||||||||
| FaxNumber: | 9199897297 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 N ENGLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | KENLY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275429290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192844149 | ||||||||
| FaxNumber: | 9192846008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIMPSON | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9199387128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.