Provider Demographics
NPI:1962575860
Name:DAVIE MEDICAL CENTER
Entity type:Organization
Organization Name:DAVIE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DAVIE MEDICAL CENTER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-713-4944
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 1:329 NC HIGHWAY 801 N
Practice Address - Street 2:
Practice Address - City:BERMUDA RUN
Practice Address - State:NC
Practice Address - Zip Code:27006-7905
Practice Address - Country:US
Practice Address - Phone:336-998-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1029251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409383Medicaid
NC3409627Medicaid