Basic Information
Provider Information | |||||||||
NPI: | 1902059173 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ANGEL MEDICAL CENTER, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1209 | ||||||||
Address2: |   | ||||||||
City: | FRANKLIN | ||||||||
State: | NC | ||||||||
PostalCode: | 287441209 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282131500 | ||||||||
FaxNumber: | 8286516570 | ||||||||
Practice Location | |||||||||
Address1: | 120 RIVERVIEW ST | ||||||||
Address2: |   | ||||||||
City: | FRANKLIN | ||||||||
State: | NC | ||||||||
PostalCode: | 287342612 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8285248411 | ||||||||
FaxNumber: | 8285242712 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/31/2008 | ||||||||
LastUpdateDate: | 06/15/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MILLER | ||||||||
AuthorizedOfficialFirstName: | RHONDA | ||||||||
AuthorizedOfficialMiddleName: | ARLENE | ||||||||
AuthorizedOfficialTitleorPosition: | VP | ||||||||
AuthorizedOfficialTelephone: | 8286514152 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | H0034 | NC | Y |   | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
ID | Type | State | Issuer | Description | 3401326 | 05 | NC |   | MEDICAID |