Provider Demographics
NPI:1902872260
Name:DUPLIN GENERAL HOSPITAL INCORPORATED
Entity Type:Organization
Organization Name:DUPLIN GENERAL HOSPITAL INCORPORATED
Other - Org Name:VIDANT DUPLIN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-296-2602
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-0278
Mailing Address - Country:US
Mailing Address - Phone:910-296-2603
Mailing Address - Fax:910-296-1174
Practice Address - Street 1:401 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349
Practice Address - Country:US
Practice Address - Phone:910-296-2603
Practice Address - Fax:910-296-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH0166273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400120SMedicaid
NC=========OtherFEDERAL TAX ID #
NC3400120SMedicaid