Healthcare Provider Details

I. General information

NPI: 1508034810
Provider Name (Legal Business Name): WASHINGTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 US HIGHWAY 64 E
PLYMOUTH NC
27962-9215
US

IV. Provider business mailing address

958 US HIGHWAY 64 E PO BOX 707
PLYMOUTH NC
27962-9216
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-7701
  • Fax: 252-793-7736
Mailing address:
  • Phone: 252-793-4135
  • Fax: 252-793-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH0006
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberH0006
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberH0006
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0006
License Number StateNC

VIII. Authorized Official

Name: MARY B. AMBROSE
Title or Position: CONTROLLER
Credential:
Phone: 252-793-7653