Healthcare Provider Details

I. General information

NPI: 1336189760
Provider Name (Legal Business Name): JOHNSTON MEMORIAL HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N ENGLEWOOD DR
KENLY NC
27542-9290
US

IV. Provider business mailing address

509 N BRIGHTLEAF BLVD P.O. BOX 1376
SMITHFIELD NC
27577-4407
US

V. Phone/Fax

Practice location:
  • Phone: 919-284-4149
  • Fax: 919-284-6008
Mailing address:
  • Phone: 919-934-8171
  • Fax: 919-989-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND EDWARD SIMPSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 919-938-7128