Provider Demographics
NPI:1386605608
Name:HOOPER & BURNETT INTERNAL MEDICINE LTD
Entity type:Organization
Organization Name:HOOPER & BURNETT INTERNAL MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-955-0916
Mailing Address - Street 1:2130 FOREST HILLS RD W STE B
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3681
Mailing Address - Country:US
Mailing Address - Phone:252-237-2700
Mailing Address - Fax:252-237-5034
Practice Address - Street 1:2130 B FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3681
Practice Address - Country:US
Practice Address - Phone:252-237-2700
Practice Address - Fax:252-237-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39649261QM1300X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890159EMedicaid
NC2311760Medicare ID - Type Unspecified