Healthcare Provider Details

I. General information

NPI: 1780653865
Provider Name (Legal Business Name): PENDER MEMORIAL HOSPITAL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E FREMONT ST
BURGAW NC
28425-5131
US

IV. Provider business mailing address

PO BOX 604271
CHARLOTTE NC
28260-4271
US

V. Phone/Fax

Practice location:
  • Phone: 910-300-4000
  • Fax:
Mailing address:
  • Phone: 336-277-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH0115
License Number StateNC

VIII. Authorized Official

Name: MS. RUTH ANN GLASER
Title or Position: PRESIDENT
Credential:
Phone: 910-300-4004