Basic Information
| Provider Information | |||||||||
| NPI: | 1770741480 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOT SPRINGS HEALTH PROGRAM | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MARS HILL MEDICAL CENTER PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69 | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287530069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286490800 | ||||||||
| FaxNumber: | 8286491032 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 MOUNTAIN VIEW RD | ||||||||
| Address2: | |||||||||
| City: | MARS HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287549500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286893507 | ||||||||
| FaxNumber: | 8286894301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 12/08/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DEMPSEY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIR OF PHCY | ||||||||
| AuthorizedOfficialTelephone: | 8286490800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | 05227 | NC | Y | Suppliers | Pharmacy | Clinic Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 575373 | 05 | NC | MEDICAID | 3411547 | 01 | NCPDP PROVIDER IDENTIFICATION NUMBER | OTHER |