1750318101 NPI number — CAROLINA FAMILY CARE, INC

Table of content: (NPI 1750318101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750318101 NPI number — CAROLINA FAMILY CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA FAMILY CARE, INC
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:
MUSC PHYSICIANS PCP
Provider Other Organization Name Type Code:
3
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:
1750318101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-6200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2125 CHARLIE HALL BLVD
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29414-5879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-571-6555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAE
Authorized Official First Name:
KARYN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
843-876-1344

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  75-17508 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP1179 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".