Basic Information
Provider Information | |||||||||
NPI: | 1841701521 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HENDERSON COUNTY HOSPITAL CORPORATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PARDEE MEDICAL ASSOCIATES FLETCHER | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 800 N JUSTICE STREET | ||||||||
Address2: | BOX 16 | ||||||||
City: | HENDERSONVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 287913410 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286948350 | ||||||||
FaxNumber: | 8286947654 | ||||||||
Practice Location | |||||||||
Address1: | 2695 HENDERSONVILLE RD STE 202 | ||||||||
Address2: |   | ||||||||
City: | ARDEN | ||||||||
State: | NC | ||||||||
PostalCode: | 287048576 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286846035 | ||||||||
FaxNumber: | 8286548152 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/20/2017 | ||||||||
LastUpdateDate: | 10/20/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KIRBY | ||||||||
AuthorizedOfficialFirstName: | JAMES | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 8286861144 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | HENDERSON COUNTY HOSPITAL CORPORATION | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | II | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.