=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902104565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAYWOOD REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2011
-----------------------------------------------------
Last Update Date | 07/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 BRETTWOOD TRCE
-----------------------------------------------------
City | CLYDE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28721-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-452-9700
-----------------------------------------------------
Fax | 828-452-3701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 BRETTWOOD TRCE
-----------------------------------------------------
City | CLYDE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28721-8021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-452-9700
-----------------------------------------------------
Fax | 828-452-3701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MICHAEL D MCKNIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-452-8210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------