MEDICARE: WILLIAMSTON HOSPITAL CORPORATION

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	275N00000X	Medicare Defined Swing Bed Hospital Unit	H0078	NC

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
2	00044	OTHER		BCBS

General Provider Information

NPI Number	:	1629049366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSTON HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 281683
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-1683
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 S MCCASKEY RD
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-2150
Country	:	US
Telephone Number	:	252-809-6179
Fax Number	:

Authorized Official
Title or Position	:	SVP FINANCE OP/AUTHORIZED OFFICIAL
Name	:	RANDY MICHAEL COOPER
Credential	:
Telephone Number	:	615-221-3840

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	08/11/2020

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Directions to “WILLIAMSTON HOSPITAL CORPORATION ” Practice Location

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