1528304235 NPI number — CABARRUS ROWAN COMMUNITY HEALTH CENTERS, INC.

Table of content: (NPI 1528304235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528304235 NPI number — CABARRUS ROWAN COMMUNITY HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CABARRUS ROWAN COMMUNITY HEALTH CENTERS, 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:
CHINA GROVE FAMILY 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:
1528304235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202D MCGILL AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-4615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-792-2242
Provider Business Mailing Address Fax Number:
704-792-2250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 E THOM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINA GROVE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28023-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-792-2245
Provider Business Practice Location Address Fax Number:
704-792-2250
Provider Enumeration Date:
12/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLOMAN
Authorized Official First Name:
DON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
704-792-2203

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  207Q00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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