MEDICARE: IREDELL MEMORIAL HOSPITAL, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417944224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IREDELL MEMORIAL HOSPITAL, INCORPORATED

Provider Business Mailing Address
First Line	:	557 BROOKDALE DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4107
Country	:	US
Telephone Number	:	704-873-5661
Fax Number	:	704-878-4611

Provider Business Practice Location Address
First Line	:	557 BROOKDALE DR
Second Line	:
City	:	STATESVILLE
State	:	NC
Zip	:	28677-4107
Country	:	US
Telephone Number	:	704-873-5661
Fax Number	:	704-878-4611

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ED RUSH
Credential	:
Telephone Number	:	704-873-5661

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	01/15/2008

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