NPIMap

Organization Active NPI

Unc Rockingham Health Care, Inc.

Doing business as Reidsville High School Student Health Center

  • Pediatric Adolescent Medicine Physician
  • Reidsville, NC
National Provider Identifier
1992830483
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
200400651 Issued in NC
Legal business name
UNC ROCKINGHAM HEALTH CARE, INC.
Doing business as
Reidsville High School Student Health Center
Practice address
1901 S Park Dr
Reidsville, NC 27320-6809
Phone
(336) 349-6443
Fax
(336) 349-6443
NPI assigned
Feb 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Authorized official

Name
Karen Ann Shadowens
Title
Cfo, VP
Phone
(336) 627-8512

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 61720 NC
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X 70791 NC
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 00-35434 NC
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X 200400651 NC Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 200698 NC
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X 300219 NC

Addresses

Primary practice location

1901 S Park Dr
Reidsville, NC 27320-6809

Mailing address

117 E Kings Hwy
Eden, NC 27288-5201
Phone (336) 623-9711

Other identifiers 1

IdentifierTypeStateIssuer
7000806MedicaidNC

Other names 1

  • Reidsville High School Student Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Morehead Hospital13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1992830483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E KINGS HWY",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885201",
            "telephone_number": "336-623-9711",
            "fax_number": "336-623-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 S PARK DR",
            "city": "REIDSVILLE",
            "state": "NC",
            "postal_code": "273206809",
            "telephone_number": "336-349-6443",
            "fax_number": "336-349-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNC ROCKINGHAM HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "SHADOWENS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CFO, VP",
        "authorized_official_telephone_number": "336-627-8512"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "61720",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "70791",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "00-35434",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NC",
            "license": "200400651",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "200698",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "300219",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000806",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reidsville High School Student Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Reidsville High School Student Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reidsville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.