Provider Demographics
NPI:1003125147
Name:CAROLINAS MEDICAL CENTER
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER
Other - Org Name:MCKAY UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-3147
Mailing Address - Street 1:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-8686
Mailing Address - Fax:704-355-8687
Practice Address - Street 1:1023 EDGEHILL RD S
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1829
Practice Address - Country:US
Practice Address - Phone:704-355-8686
Practice Address - Fax:704-355-8687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty