Healthcare Provider Details

I. General information

NPI: 1760076467
Provider Name (Legal Business Name): ALLEGHANY COUNTY MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 DOCTORS ST
SPARTA NC
28675-9247
US

IV. Provider business mailing address

233 DOCTORS ST
SPARTA NC
28675-9247
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5511
  • Fax: 336-372-6211
Mailing address:
  • Phone: 336-372-5511
  • Fax: 336-372-8451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLA RENEE COLEMAN
Title or Position: MEDICAL STAFF COORDINATOR
Credential:
Phone: 336-372-3127