1518944107 NPI number — CAROLINA PATHOLOGY ASSOCIATES LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518944107 NPI number — CAROLINA PATHOLOGY ASSOCIATES LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA PATHOLOGY ASSOCIATES LLP
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:
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:
1518944107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602399
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:
28260-2399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-350-2889
Provider Business Mailing Address Fax Number:
804-545-0652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-725-4822
Provider Business Practice Location Address Fax Number:
864-725-4679
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEOD
Authorized Official First Name:
DARRYL
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
864-725-4822

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CD1791 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 736121 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA5798 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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