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
1	207Q00000X	Family Medicine Physician
2	207Y00000X	Otolaryngology Physician
3	207RG0100X	Gastroenterology Physician
4	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF3472	OTHER	NC	RR MEDICARE

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
3	017PK	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1811902349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALDWELL MEMORIAL HOSPITAL, INC

Provider Business Mailing Address
First Line	:	322 MULBERRY ST SW
Second Line	:	MEDICAL STAFF SERVICES
City	:	LENOIR
State	:	NC
Zip	:	28645-5702
Country	:	US
Telephone Number	:	828-757-5965
Fax Number	:	828-757-5104

Provider Business Practice Location Address
First Line	:	4355 HICKORY BLVD
Second Line	:	UPPER SUITE
City	:	GRANITE FALLS
State	:	NC
Zip	:	28630-1992
Country	:	US
Telephone Number	:	828-757-5060
Fax Number	:	828-757-5064

Authorized Official
Title or Position	:	VP/ COO/CNO
Name	:	REBECCA T SMITH
Credential	:
Telephone Number	:	828-757-5100

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/29/2015

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Directions to “CALDWELL MEMORIAL HOSPITAL, INC ” Practice Location

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