Provider Demographics
NPI:1538441092
Name:CLEVELAND REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:CLEVELAND REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-487-3390
Mailing Address - Street 1:201 E. GROVER ST.
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150
Mailing Address - Country:US
Mailing Address - Phone:980-487-3953
Mailing Address - Fax:
Practice Address - Street 1:201 E. GROVER ST.
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:980-487-3953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000753133V00000X
NCL002365133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851684146OtherINDIVIDUAL NPI
NC1619260841OtherINDIVIDUAL NPI