=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023356565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MCDOWELL HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2013
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 NEBO SCHOOL RD
-----------------------------------------------------
City | NEBO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28761-6924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-659-5791
-----------------------------------------------------
Fax | 828-652-9994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 NEBO SCHOOL RD
-----------------------------------------------------
City | NEBO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28761-6924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-659-5791
-----------------------------------------------------
Fax | 828-652-9994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY DIRECTOR
-----------------------------------------------------
Name | TIMOTHY GENTILCORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-213-0048
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 11438
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------