MEDICARE: PRESBYTERIAN REGIONAL HEALTHCARE CORP

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	207R00000X	Internal Medicine Physician

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

General Provider Information

NPI Number	:	1548223803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN REGIONAL HEALTHCARE CORP

Provider Business Mailing Address
First Line	:	1900 RANDOLPH RD
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1106
Country	:	US
Telephone Number	:	704-384-9103
Fax Number	:	704-316-9633

Provider Business Practice Location Address
First Line	:	15825 JOHN J DELANEY DR
Second Line	:	SUITE 200
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3146
Country	:	US
Telephone Number	:	704-384-1925
Fax Number	:	704-384-1930

Authorized Official
Title or Position	:	SR. VICE PRESIDENT
Name	:	MR. PATRICK D EASTERLING
Credential	:
Telephone Number	:	704-384-9103

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	08/22/2020

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