MEDICARE: CALDWELL MEMORIAL HOSPITAL, 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1578949079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALDWELL MEMORIAL HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	321 MULBERRY ST SW
Second Line	:	MEDICAL STAFF SERVICES
City	:	LENOIR
State	:	NC
Zip	:	28645-5720
Country	:	US
Telephone Number	:	828-757-5965
Fax Number	:	828-757-5104

Provider Business Practice Location Address
First Line	:	8439 VALLEY BLVD
Second Line	:
City	:	BLOWING ROCK
State	:	NC
Zip	:	28605-9052
Country	:	US
Telephone Number	:	828-295-3116
Fax Number	:	828-295-4388

Authorized Official
Title or Position	:	CFO
Name	:	KAREN SHADOWENS
Credential	:
Telephone Number	:	336-627-8512

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	01/21/2025

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