Provider Demographics
NPI:1053351031
Name:WASHINGTON REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:WASHINGTON REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:TITUS
Authorized Official - Last Name:AVIGNONE
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:214-502-9624
Mailing Address - Street 1:7920 BELT LINE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8155
Mailing Address - Country:US
Mailing Address - Phone:214-502-9624
Mailing Address - Fax:252-793-1530
Practice Address - Street 1:958 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9216
Practice Address - Country:US
Practice Address - Phone:252-793-4135
Practice Address - Fax:252-793-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406631Medicaid
566003224OtherCOMMERCIAL AMBULANCE
00573OtherBCBSNC AMBULANCE
566003224001OtherCHAMPUS AMBULANCE
00573OtherBCBSNC AMBULANCE