Provider Demographics
NPI:1053547976
Name:HOLDEN BEACH MEDICAL CENTER, PA
Entity type:Organization
Organization Name:HOLDEN BEACH MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERROW
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-842-5991
Mailing Address - Street 1:2930 HOLDEN BEACH RD SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-5702
Mailing Address - Country:US
Mailing Address - Phone:910-842-5991
Mailing Address - Fax:910-842-5994
Practice Address - Street 1:2930 HOLDEN BEACH RD SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-5702
Practice Address - Country:US
Practice Address - Phone:910-842-5991
Practice Address - Fax:910-842-5994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103587261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care