MEDICARE: HOSPICE OF MCDOWELL COUNTY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	HOS1153	NC
2	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0024E	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1467451088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF MCDOWELL COUNTY INC

Provider Business Mailing Address
First Line	:	575 AIRPORT ROAD
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752-3103
Country	:	US
Telephone Number	:	828-652-1318
Fax Number	:	828-659-1631

Provider Business Practice Location Address
First Line	:	575 AIRPORT ROAD
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752
Country	:	US
Telephone Number	:	828-652-1318
Fax Number	:	828-659-1631

Authorized Official
Title or Position	:	INTERIM EXECUTIVE DIRECTOR
Name	:	MR. W. RAY MCKESSON
Credential	:
Telephone Number	:	828-652-1318

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	11/17/2009

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Directions to “HOSPICE OF MCDOWELL COUNTY INC ” Practice Location

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