NPIMap

Organization Active NPI

Northern Hospital of Surry County

Doing business as Revival a Department of Northern Hospital

  • Clinic Pharmacy
  • Elkin, NC
National Provider Identifier
1588099022
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
11612 Issued in NC
Legal business name
NORTHERN HOSPITAL OF SURRY COUNTY
Doing business as
Revival a Department of Northern Hospital
Practice address
110 Dutchman CT
Elkin, NC 28621-2237
Phone
(336) 835-5330
Fax
(336) 526-1399
NPI assigned
Sep 3, 2013
Last updated
Mar 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHERN HOSPITAL DISTRICT OF SURRY COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Mrs. Robin Hodgin, RN, MHA
Title
V. President of Patient Services &
Phone
(336) 719-7019

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 11612 NC Primary

Addresses

Primary practice location

110 Dutchman CT
Elkin, NC 28621-2237

Mailing address

PO Box 1101
Mount Airy, NC 27030-1101
Phone (336) 719-7000

Other identifiers 2

IdentifierTypeStateIssuer
2141874OtherPK
89132UVMedicaidNC

Other names 1

  • Revival a Department of Northern Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northern Home Care13 organizations share this tax ID, including this one
Part of
Northern Home Care

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1588099022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1101",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270301101",
            "telephone_number": "336-719-7000",
            "fax_number": "336-719-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 DUTCHMAN CT",
            "city": "ELKIN",
            "state": "NC",
            "postal_code": "286212237",
            "telephone_number": "336-835-5330",
            "fax_number": "336-526-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN HOSPITAL OF SURRY COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY",
        "enumeration_date": "2013-09-03",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "HODGIN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "V. PRESIDENT OF PATIENT SERVICES &",
        "authorized_official_telephone_number": "336-719-7019",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MHA"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NC",
            "license": "11612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141874",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89132UV",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revival a Department of Northern Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revival a Department of Northern Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkin, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.