NPIMap

Organization Active NPI

Iredell Mem Hospital Cap Program

  • General Acute Care Hospital
  • Statesville, NC
National Provider Identifier
1376688283
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
IREDELL MEM HOSPITAL CAP PROGRAM
Practice address
557 Brookdale Drive
Statesville, NC 28677
Phone
(704) 873-5661
NPI assigned
Feb 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ed Rush
Title
President
Phone
(704) 873-5661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NC Primary

Addresses

Primary practice location

557 Brookdale Drive
Statesville, NC 28677

Mailing address

557 Brookdale Drive
Statesville, NC 28677
Phone (704) 873-5661

Other identifiers 1

IdentifierTypeStateIssuer
3408671MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Imh Professional Rad11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376688283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 BROOKDALE DRIVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-873-5661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 BROOKDALE DRIVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-873-5661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL MEM HOSPITAL CAP PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-873-5661",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408671",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.