Healthcare Provider Details

I. General information

NPI: 1912032095
Provider Name (Legal Business Name): UNC ROCKINGHAM HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 NC HIGHWAY 135
MAYODAN NC
27027-8126
US

IV. Provider business mailing address

117 E KINGS HWY
EDEN NC
27288-5201
US

V. Phone/Fax

Practice location:
  • Phone: 336-427-4335
  • Fax: 336-427-4335
Mailing address:
  • Phone: 336-623-9711
  • Fax: 336-623-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number61720
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70791
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00-35434
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200698
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300219
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number200400651
License Number StateNC

VIII. Authorized Official

Name: KAREN ANN SHADOWENS
Title or Position: CFO, VP
Credential:
Phone: 336-627-8512