Basic Information
| Provider Information | |||||||||
| NPI: | 1356318968 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGHANY COUNTY MEMORIAL HOSPITAL INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ALLEGHANY HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 233 DOCTORS ST | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363725511 | ||||||||
| FaxNumber: | 3363726563 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 DOCTORS ST | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363725511 | ||||||||
| FaxNumber: | 3363726563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | MARLA | ||||||||
| AuthorizedOfficialMiddleName: | RENEE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL STAFF COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3363723127 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | H0108 | NC | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 00015 | 01 | NC | NC BLUE CROSS HOSPITAL | OTHER | 010194377 | 05 | VA | MEDICAID | 660HOS | 01 | NC | PARTNERS MCR CHOICE | OTHER | 07692 | 01 | NC | NC BCBS PROFESSIONAL | OTHER | 00971 | 01 | NC | NC BCBS SWING BED | OTHER | 235003 | 01 | NC | CIGNA MEDICARE | OTHER | 442042 | 01 | VA | ANTHEM BCBS OF VA | OTHER | 091278600 | 05 | FL | MEDICAID | 152167500 | 01 | NC | ACS | OTHER | 009810234 | 05 | VA | MEDICAID | 3401320 | 05 | NC | MEDICAID |