Basic Information
Provider Information | |||||||||
NPI: | 1659564433 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DUPLIN GENERAL HOSPITAL INCORPORATED | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DUPLIN GENERAL HOSPITAL INC ANESTHESIA DEAPARTMENT | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 278 | ||||||||
Address2: |   | ||||||||
City: | KENANSVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 283490278 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102962608 | ||||||||
FaxNumber: | 9102961174 | ||||||||
Practice Location | |||||||||
Address1: | 401 NORTH MAIN STREET | ||||||||
Address2: | ANESTHESIA DEPARTMENT | ||||||||
City: | KENANSVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 283499989 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102962608 | ||||||||
FaxNumber: | 9102961174 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/24/2007 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CASE | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | HARVEY | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCIAL SERVICE | ||||||||
AuthorizedOfficialTelephone: | 9102960941 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X |   | NC | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X |   | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.