Healthcare Provider Details

I. General information

NPI: 1487691457
Provider Name (Legal Business Name): PRESBYTERIAN REGIONAL HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 RANDOLPH RD
CHARLOTTE NC
28207-1216
US

IV. Provider business mailing address

1900 RANDOLPH RD SUITE 500
CHARLOTTE NC
28207-1106
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-5800
  • Fax: 704-372-5657
Mailing address:
  • Phone: 704-384-9113
  • Fax: 704-384-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK EASTERLING
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 704-384-9113