Provider Demographics
NPI:1588793624
Name:DAVIE COUNTY EMERGENCY HEALTH CORP
Entity type:Organization
Organization Name:DAVIE COUNTY EMERGENCY HEALTH CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-702-5501
Mailing Address - Street 1:223 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2038
Mailing Address - Country:US
Mailing Address - Phone:336-702-5500
Mailing Address - Fax:336-702-5701
Practice Address - Street 1:223 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2038
Practice Address - Country:US
Practice Address - Phone:336-702-5500
Practice Address - Fax:336-702-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC943133282NC0060X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3451313Medicaid
NC34Z313Medicare Oscar/Certification