Provider Demographics
NPI:1073560850
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:MIDLAND FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:12925 HIGHWAY 601
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-9535
Mailing Address - Country:US
Mailing Address - Phone:704-888-3702
Mailing Address - Fax:704-888-4192
Practice Address - Street 1:12925 HIGHWAY 601
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-9535
Practice Address - Country:US
Practice Address - Phone:704-888-3702
Practice Address - Fax:704-888-4192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019F0OtherBCBS EFF 7-1-07
NC566000156032OtherTRICARE STANDARD, NON NWK
NC9805OtherPARTNERS MEDICARE CHOICE
NC355573OtherMAMSI GROUP
NC5906966Medicaid
NCCC2854OtherRAILROAD MEDICARE GROUP
NC790298RMedicaid
NC0298ROtherBCBS EFF PRIOR TO 7-1-07
NCDF8926OtherRAILROAD MEDICARE PTAN
NC019F0OtherBCBS EFF 7-1-07
NC2325363Medicare PIN
NC232009Medicare PIN