Provider Demographics
NPI:1588099022
Name:NORTHERN HOSPITAL OF SURRY COUNTY
Entity type:Organization
Organization Name:NORTHERN HOSPITAL OF SURRY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT OF PATIENT SERVICES &
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHA
Authorized Official - Phone:336-719-7019
Mailing Address - Street 1:PO BOX 1101
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1101
Mailing Address - Country:US
Mailing Address - Phone:336-719-7000
Mailing Address - Fax:336-719-7199
Practice Address - Street 1:110 DUTCHMAN CT
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2237
Practice Address - Country:US
Practice Address - Phone:336-835-5330
Practice Address - Fax:336-526-1399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-03
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116123336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141874OtherPK
NC89132UVMedicaid