MEDICARE: PAM SPECIALTY HOSPITAL OF ROCKY MOUNT LLC

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	284300000X	Special Hospital
2	282E00000X	Long Term Care Hospital

General Provider Information

NPI Number	:	1861049371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAM SPECIALTY HOSPITAL OF ROCKY MOUNT LLC

Provider Business Mailing Address
First Line	:	1828 GOOD HOPE RD
Second Line	:
City	:	ENOLA
State	:	PA
Zip	:	17025-1203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 NOELL LN
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1761
Country	:	US
Telephone Number	:	252-451-2300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY MISITANO
Credential	:
Telephone Number	:	717-731-9660

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	09/28/2021

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