1023055365 NPI number — RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, INC.

Table of content: (NPI 1023055365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023055365 NPI number — RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION ONCOLOGY CENTERS OF THE CAROLINAS, 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:
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:
1023055365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 QUEENS RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28204-3252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-333-7376
Provider Business Mailing Address Fax Number:
704-333-3397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 MEDICAL PARK RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28117-8521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-235-2580
Provider Business Practice Location Address Fax Number:
704-235-2599
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARKER
Authorized Official First Name:
CANDICE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
704-333-7376

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5902249 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2572429 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 017JP . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: GPO441 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com