Healthcare Provider Details

I. General information

NPI: 1114068780
Provider Name (Legal Business Name): PUNGO DISTRICT HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E WATER ST
BELHAVEN NC
27810-1450
US

IV. Provider business mailing address

202 E WATER ST
BELHAVEN NC
27810-1450
US

V. Phone/Fax

Practice location:
  • Phone: 252-943-2111
  • Fax: 252-944-2236
Mailing address:
  • Phone: 252-943-2111
  • Fax: 252-944-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number04076
License Number StateNC

VIII. Authorized Official

Name: WILLIAM HARVEY CASE
Title or Position: PRESIDENT
Credential:
Phone: 252-943-2111