=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538370150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTER BANKS HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 08/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 S CROATAN HWY
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-9704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-277-8151
-----------------------------------------------------
Fax | 336-841-6217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 S CROATAN HWY
-----------------------------------------------------
City | NAGS HEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27959-9704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-277-8151
-----------------------------------------------------
Fax | 336-841-6217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CPA
-----------------------------------------------------
Name | TODD WARLITNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-449-4514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------