Provider Demographics
NPI:1316105364
Name:PRESBYTERIAN REGIONAL HEALTHCARE CORP
Entity type:Organization
Organization Name:PRESBYTERIAN REGIONAL HEALTHCARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9104
Mailing Address - Street 1:1733 SEASIDE RD SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-5849
Mailing Address - Country:US
Mailing Address - Phone:910-575-9099
Mailing Address - Fax:910-575-9103
Practice Address - Street 1:1733 SEASIDE RD SW
Practice Address - Street 2:SUITE C
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-5849
Practice Address - Country:US
Practice Address - Phone:910-575-9099
Practice Address - Fax:910-575-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB055Medicaid
SCNPB055Medicaid