1073861266 NPI number — CAROLINAS PHYSICIANS NETWORK, INC.

Table of content: (NPI 1073861266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073861266 NPI number — CAROLINAS PHYSICIANS NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
CAROLINAS PHYSICIANS NETWORK, 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:
CAROLINAS HEALTHCARE SYSTEM PULMONARY & SLEEP MEDICINE
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:
1073861266
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601888
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:
28260-1888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-512-4808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 PROVIDENCE RD S
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
WAXHAW
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28173-6313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-226-0413
Provider Business Practice Location Address Fax Number:
704-296-5646
Provider Enumeration Date:
08/21/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAYMON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
FORD
Authorized Official Title or Position:
SVP
Authorized Official Telephone Number:
704-446-8250

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1073861266 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5921144 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPB494 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".