=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386121929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARNETT HEALTH SYSTEM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2018
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 BRIGHTWATER DR STE 100
-----------------------------------------------------
City | LILLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27546-5156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-984-3080
-----------------------------------------------------
Fax | 910-615-9766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1706
-----------------------------------------------------
City | DUNN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28335-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP MANAGED CARE/REVENUE CYCLE
-----------------------------------------------------
Name | JOSEPH BARTON FISER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-615-5572
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------