Provider Demographics
NPI:1093844854
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Other - Org Name:UNC PHYSICIANS & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-843-4810
Mailing Address - Street 1:143 W FRANKLIN STREET
Mailing Address - Street 2:SUITE #600
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2539
Mailing Address - Country:US
Mailing Address - Phone:919-843-4830
Mailing Address - Fax:919-843-6949
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-843-4810
Practice Address - Fax:919-843-6949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7907035Medicaid
NC7907035Medicaid
NC0004Medicare PIN
NC0911240001Medicare NSC
NC346553Medicare Oscar/Certification