Healthcare Provider Details

I. General information

NPI: 1194139964
Provider Name (Legal Business Name): SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N CROATAN HWY
KITTY HAWK NC
27949-3990
US

IV. Provider business mailing address

5200 N CROATAN HWY
KITTY HAWK NC
27949-3990
US

V. Phone/Fax

Practice location:
  • Phone: 252-255-6020
  • Fax:
Mailing address:
  • Phone: 252-255-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT A BROERMANN
Title or Position: SR VP/CFO
Credential:
Phone: 757-455-7020