Basic Information
| Provider Information | |||||||||
| NPI: | 1548237464 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOT SPRINGS HEALTH PROGRAM | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BARNARDSVILLE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287530069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286490800 | ||||||||
| FaxNumber: | 8286493786 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 DILLINGHAM RD | ||||||||
| Address2: | |||||||||
| City: | BARNARDSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287099754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286263965 | ||||||||
| FaxNumber: | 8286263784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STROM | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8286490800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOT SPRINGS HEALTH PROGRAM | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 01663 | 01 | NC | BCBS | OTHER | 344531A & C | 05 | NC | MEDICAID | CA4200 | 01 | NC | UNITEDHEALTH PRIMARY CARE | OTHER |