Healthcare Provider Details

I. General information

NPI: 1942521976
Provider Name (Legal Business Name): LORIS COMMUNITY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 SEASIDE RD SW SUITE B
OCEAN ISLE BEACH NC
28469-5849
US

IV. Provider business mailing address

1733 SEASIDE RD SW SUITE B
OCEAN ISLE BEACH NC
28469-5849
US

V. Phone/Fax

Practice location:
  • Phone: 910-575-8488
  • Fax: 910-575-6542
Mailing address:
  • Phone: 910-575-8488
  • Fax: 910-575-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC201015300336
License Number StateNC

VIII. Authorized Official

Name: CAROLYN WARD
Title or Position: LORIS PHYSICIAN CREDENTIALING
Credential:
Phone: 919-880-6406