Provider Demographics
NPI:1073821781
Name:CAROLINA HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:CAROLINA HEALTHCARE ASSOCIATES INC
Other - Org Name:UROLOGY COMPREHENSIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-667-7597
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-254-1033
Mailing Address - Fax:910-343-0171
Practice Address - Street 1:209B US HIGHWAY 117 N
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5101
Practice Address - Country:US
Practice Address - Phone:910-254-1033
Practice Address - Fax:910-343-0171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA HEALTHCARE ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-15
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916788Medicaid
NC1073821781Medicaid
NC5916788Medicaid