MEDICARE: HOSPITALIST MEDICINE PHYSICIANS OF NORTH CAROLINA - CLYDE PC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1770431181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPITALIST MEDICINE PHYSICIANS OF NORTH CAROLINA - CLYDE PC

Provider Business Mailing Address
First Line	:	1222 DEMONBREUN ST STE 1601
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-7092
Country	:	US
Telephone Number	:	253-682-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	566 RUIN CREEK RD
Second Line	:
City	:	HENDERSON
State	:	NC
Zip	:	27536-2927
Country	:	US
Telephone Number	:	252-438-4143
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LAURA FALL
Credential	:
Telephone Number	:	253-682-6040

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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