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Organization
MOREHEAD MEMORIAL HOSPITAL
Active
Organization
MOREHEAD MEMORIAL HOSPITAL
Active
Other names
Family Practice of Eden
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA L. HUNT (VP OF PRACTICE MANAGEMENT)
(336) 623-9711
Entity
Organization
Contact information
Practice address
515 THOMPSON ST, #D, EDEN, NC 27288-5068
(336) 627-5178
Mailing address
515 THOMPSON ST, #D, EDEN, NC 27288-5068
(336) 627-5178
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0129X
BLUE CROSS
NC
01
—
235082G
MEDICARE GRP PIN
NC
01
—
5950636
MEDICAID GROUP # - EFFECTIVE 1/1/09
NC
01
—
890129X
MEDICAID GROUP # TERMINATED 3/1/09
NC
Enumeration date
09/04/2006
Last updated
03/02/2009
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