Healthcare Provider Details

I. General information

NPI: 1831300870
Provider Name (Legal Business Name): PENDER MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 US HWY 117
ROCKY POINT NC
28457
US

IV. Provider business mailing address

507 E FREMONT ST
BURGAW NC
28425-5131
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-5451
  • Fax:
Mailing address:
  • Phone: 910-259-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberH0115
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberH0115
License Number StateNC

VIII. Authorized Official

Name: MR. DAVID LONG
Title or Position: SITE EXECUTIVE DIRECTOR
Credential:
Phone: 910-259-5451