Basic Information
| Provider Information | |||||||||
| NPI: | 1861567182 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WRMC HOSPITAL OPERATING CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WRMC PROFESSIONAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 W D ST | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
| FaxNumber: | 3366518465 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 W D ST | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
| FaxNumber: | 3366518465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PERRYMAN | ||||||||
| AuthorizedOfficialFirstName: | KAYE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATE COMPLIANCE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3366518060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8000201 | 05 | NC | MEDICAID |