Healthcare Provider Details

I. General information

NPI: 1932107547
Provider Name (Legal Business Name): NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ROCKFORD ST
MOUNT AIRY NC
27030-5322
US

IV. Provider business mailing address

PO BOX 1101
MOUNT AIRY NC
27030-1101
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-7000
  • Fax: 336-719-7199
Mailing address:
  • Phone: 336-719-7000
  • Fax: 336-719-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH0184
License Number StateNC

VIII. Authorized Official

Name: ROBIN ALLEN
Title or Position: DIRECTOR CENTRAL BILLING
Credential:
Phone: 336-719-7129