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Hospice of Surry County, Inc

Organization Active NPI Community Based Hospice Care Agency · Dobson, NC

NPI 1851355424 · NPPES record last updated Sep 28, 2023

Key facts

NPI
1851355424
Entity type
Organization (NPI type 2)
Primary specialty
Community Based Hospice Care Agency 251G00000X
License
HOS1001 (NC)
Legal business name
HOSPICE OF SURRY COUNTY, INC
Practice address
105 N Crutchfield St Unit 2
Dobson, NC 27017-8804
Phone
(336) 789-2922
Fax
(336) 789-0856
NPI assigned
Apr 12, 2006
Organization subpart
No

Authorized official

Name
Mrs. Tracey Smith Dobson, RN, BSN
Title
Interim Ceo
Phone
(336) 789-2922

Owners & managing parties with NPI records 13

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 23

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospice

Listed as
Mountain Valley Hospice & Palliative Care CCN 341546
Ownership
Non-Profit
Certified
Jan 5, 1990
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NC

Hospice certification: CCN 341546

Legal name
HOSPICE OF SURRY COUNTY INC
Doing business as
MOUNTAIN VALLEY HOSPICE & PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 5, 1990
Last certification
Jun 27, 2007
Ownership / control type
Non-Profit - Private
Organization structure
Corporation · Non-profit
Incorporated
Nov 8, 1982 in NC
Enrollment address
105 N Crutchfield St
Unit 2
Dobson, NC 27017-8804

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Northern Hospital of Surry County
Organization · Mount Airy, NC 		5% Or Greater Direct Ownership Interest Oct 1, 2005 50%
Barry S Dowell
Individual 		Corporate Officer
Cfo		 Oct 23, 2017
W-2 Managing Employee Oct 23, 2017
Hugh Chatham Memorial Hospital Inc
Organization · Elkin, NC
Non-profit 		5% Or Greater Direct Ownership Interest Oct 1, 2005 50%
Glenn Golaszewski
Individual 		Contracted Managing Employee
MD;		 Sep 2, 2008
Tracey Smith Dobson
Individual 		Corporate Officer
Interim Ceo		 May 20, 2020
Corporate Director
Interim Ceo		 May 20, 2020
W-2 Managing Employee
Ad;		 May 20, 2020
Tara Dowell
Individual 		W-2 Managing Employee Sep 26, 2007

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mountain Valley
Fort Mill, SC · CCN 421654		 Hospice 5% Or Greater Indirect Ownership Interest (8%) Dec 11, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050701000267 NC Part a Provider - Hospice 2961448741 Practice locations: Yadkinville, NC; Pilot Mountain, NC; Dobson, NC; Elkin, NC
O20080929000387 NC Part B Supplier - Clinic/Group Practice 2961448741 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: King, NC; Yadkinville, NC; Winston Salem, NC; Pilot Mountain, NC; Mount Airy, NC; Dobson, NC; Elkin, NC

National Provider Directory

Locations

945 Zephyr Rd
Dobson, NC 27017
Phone (336) 356-5000

151 N Crutchfield St
Unit 2
Dobson, NC 27017

968 N Bridge St
Elkin, NC 28621

401 Technology Ln
Ste 200
Mount Airy, NC 27030
Phone (336) 789-2922

1427 Edgewood Dr
Mount Airy, NC 27030
Phone (336) 789-2922

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HOS0404 NC
Community Based Hospice Care Agency 251G00000X HOS1303 NC
Community Based Hospice Care Agency 251G00000X HC1498 NC
Community Based Hospice Care Agency 251G00000X HOS1001 NC Yes

Addresses

Primary practice location

105 N Crutchfield St Unit 2
Dobson, NC 27017-8804

Mailing address

PO Box 325
Dobson, NC 27017-0325
Phone (336) 789-2922

Other practice location 1

688 N Bridge St
Elkin, NC 28621-3005
Phone (336) 526-2650

Other practice location 2

129 Veterans Dr
Pilot Mountain, NC 27041-9609
Phone (336) 368-1260

Other practice location 3

243 N Lee Ave
Yadkinville, NC 27055-5431
Phone (336) 677-1692

Other practice location 4

945 Zephyr Rd
Dobson, NC 27017-7708
Phone (336) 356-5000

Other identifiers

IdentifierTypeStateIssuer
3401546MedicaidNC
0020MOtherNCBCBS

Other names

  • Mountain Valley Doing business as
  • Mountain Valley Hospice and Palliative Care Doing business as

Other providers in Dobson, NC

All providers in Dobson, NC · Community Based Hospice Care Agency in North Carolina

Sources for this page

Verify at the official NPI Registry.