Provider Demographics
NPI:1902104565
Name:HAYWOOD REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:HAYWOOD REGIONAL MEDICAL CENTER
Other - Org Name:BLUE MOUNTAIN UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-452-8210
Mailing Address - Street 1:15 BRETTWOOD TRCE
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8021
Mailing Address - Country:US
Mailing Address - Phone:828-452-9700
Mailing Address - Fax:828-452-3701
Practice Address - Street 1:15 BRETTWOOD TRCE
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8021
Practice Address - Country:US
Practice Address - Phone:828-452-9700
Practice Address - Fax:828-452-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235054HMedicare PIN