Provider Demographics
NPI:1417783705
Name:IREDELL MEMORIAL HOSPITAL INCORPORATED
Entity type:Organization
Organization Name:IREDELL MEMORIAL HOSPITAL INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:IREDELL HEALTH SYSTEM
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SAFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-878-7609
Mailing Address - Street 1:PO BOX 896322
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 OLD MOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-1930
Practice Address - Country:US
Practice Address - Phone:704-873-0281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital