=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053444901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENDER MEMORIAL HOSPITAL INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 10/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 E FREMONT ST
-----------------------------------------------------
City | BURGAW
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28425-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-259-5451
-----------------------------------------------------
Fax | 910-259-7136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 604271
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-4271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-277-8757
-----------------------------------------------------
Fax | 336-718-8916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & COO
-----------------------------------------------------
Name | RUTH ANN GLASER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-300-4004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | H0115
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------