Healthcare Provider Details

I. General information

NPI: 1972593051
Provider Name (Legal Business Name): HOOTS MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W MAIN ST
YADKINVILLE NC
27055-7804
US

IV. Provider business mailing address

PO BOX 68
YADKINVILLE NC
27055-0068
US

V. Phone/Fax

Practice location:
  • Phone: 336-679-6776
  • Fax: 336-679-6716
Mailing address:
  • Phone: 336-679-6776
  • Fax: 336-679-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH0155
License Number StateNC

VIII. Authorized Official

Name: MRS. JULIA NORMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 336-679-6776