1578709325 NPI number — CAROLINAS MEDICAL CENTER-NORTHEAST

Table of content: (NPI 1578709325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578709325 NPI number — CAROLINAS MEDICAL CENTER-NORTHEAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS MEDICAL CENTER-NORTHEAST
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:
1578709325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 PENNY LN
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28025-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-403-7780
Provider Business Mailing Address Fax Number:
704-403-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 PENNY LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28025-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-403-7780
Provider Business Practice Location Address Fax Number:
704-403-7781
Provider Enumeration Date:
12/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOWDER
Authorized Official First Name:
FRIEDA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
704-403-4146

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DF8926 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5950737 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com