Healthcare Provider Details

I. General information

NPI: 1932421872
Provider Name (Legal Business Name): THE PRESBYTERIAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BALDWIN AVE SUITE 100
CHARLOTTE NC
28204-3370
US

IV. Provider business mailing address

PO BOX 601529
CHARLOTTE NC
28260-1529
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1900
  • Fax: 704-384-1924
Mailing address:
  • Phone: 704-316-1900
  • Fax: 704-316-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY S. VANCE
Title or Position: SVP & COO OF PRESBYTERIAN HOSPITAL
Credential:
Phone: 704-384-7283