Healthcare Provider Details

I. General information

NPI: 1902104565
Provider Name (Legal Business Name): HAYWOOD REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BRETTWOOD TRCE
CLYDE NC
28721-8021
US

IV. Provider business mailing address

15 BRETTWOOD TRCE
CLYDE NC
28721-8021
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-9700
  • Fax: 828-452-3701
Mailing address:
  • Phone: 828-452-9700
  • Fax: 828-452-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D MCKNIGHT
Title or Position: CFO
Credential:
Phone: 828-452-8210