=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174841431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAH ACQUISITION COMPANY 10 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2010
-----------------------------------------------------
Last Update Date | 07/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 624 W MAIN ST
-----------------------------------------------------
City | YADKINVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27055-7804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-679-2041
-----------------------------------------------------
Fax | 336-679-6717
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 MAIN ST STE 2350
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64105-5186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-679-2041
-----------------------------------------------------
Fax | 336-679-6717
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MRS. JULIA NORMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-679-2041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | H0155
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | H0155
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------