Provider Demographics
NPI:1073988994
Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Other - Org Name:ATRIUM HEALTH STANLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFURIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-3304
Mailing Address - Street 1:PO BOX 32861
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0008282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400119Medicaid
NC340119Medicare Oscar/Certification