Provider Demographics
NPI:1699943415
Name:JOHN H SHERRILL
Entity type:Organization
Organization Name:JOHN H SHERRILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-874-2061
Mailing Address - Street 1:560 MALCOLM BOULAVARD
Mailing Address - Street 2:PO BOX 815
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671
Mailing Address - Country:US
Mailing Address - Phone:828-874-2061
Mailing Address - Fax:828-874-2278
Practice Address - Street 1:560 MALCOLM BLVD
Practice Address - Street 2:
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671-0815
Practice Address - Country:US
Practice Address - Phone:828-874-2061
Practice Address - Fax:828-874-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22973291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2317609Medicare PIN
NCC81212Medicare UPIN