1568424547 NPI number — CAROLINAS MEDICAL CENTER-NORTHEAST

Table of content: (NPI 1568424547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568424547 NPI number — CAROLINAS MEDICAL CENTER-NORTHEAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS MEDICAL CENTER-NORTHEAST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568424547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 202B
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-2981
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-403-2626
Provider Business Mailing Address Fax Number:
704-784-8615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 202B
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-2981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-2626
Provider Business Practice Location Address Fax Number:
704-784-8615
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWDER
Authorized Official First Name:
FRIEDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VP PHYSICIAN SERVICES
Authorized Official Telephone Number:
704-403-4146

Provider Taxonomy Codes

  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016GN . This is a "BCBS GROUP ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: QPB658 . This is a "S.C. MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 396408 . This is a "MAMSI GROUP NO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89135FE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 561878722001 . This is a "TRICARE STANDARD, NON NWK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: DF8926 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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