Provider Demographics
NPI:1073838496
Name:CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK, INC.
Other - Org Name:THE SANGER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-631-0002
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-373-0212
Mailing Address - Fax:704-342-5871
Practice Address - Street 1:6030 WEST HIGHWAY 74
Practice Address - Street 2:SUITE F
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3469
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:704-342-5871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-29
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905994Medicaid
SCNPB215Medicaid
NC2331634CMedicare PIN