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General NPI Number Information
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NPI Number | 1053547976
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Entity Type | Organization
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Legal Business Name | HOLDEN BEACH MEDICAL CENTER, PA
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 2930 HOLDEN BEACH RD SW
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City | SUPPLY
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State | NC
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Zip | 28462-5702
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Country | US
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Telephone | 910-842-5991
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Fax | 910-842-5994
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Provider Business Mailing Address
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Address Line | 2930 HOLDEN BEACH RD SW
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City | SUPPLY
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State | NC
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Zip | 28462-5702
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Country | US
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Telephone | 910-842-5991
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Fax | 910-842-5994
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEATHER MERROW
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Credential | PA-C
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Telephone | 910-842-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 103587
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License Number State | NC
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