Healthcare Provider Details

I. General information

NPI: 1295703130
Provider Name (Legal Business Name): PENDER MEMORIAL HOSPITAL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
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: 910-259-5451
  • Fax:
Mailing address:
  • Phone: 336-277-8757
  • Fax: 336-718-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH0115
License Number StateNC

VIII. Authorized Official

Name: RUTH ANN GLASER
Title or Position: PRESIDENT
Credential:
Phone: 910-259-5451