Provider Demographics
NPI:1104009323
Name:FIRSTHEALTH OF THE CAROLINAS, INC
Entity Type:Organization
Organization Name:FIRSTHEALTH OF THE CAROLINAS, INC
Other - Org Name:FIRSTHEALTH CARDIOVASCULAR AND THORACIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEJACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-1913
Mailing Address - Street 1:PO BOX 843427
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3427
Mailing Address - Country:US
Mailing Address - Phone:910-715-4111
Mailing Address - Fax:910-715-4101
Practice Address - Street 1:35 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8708
Practice Address - Country:US
Practice Address - Phone:910-715-4111
Practice Address - Fax:910-715-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB284Medicaid
NC020CXOtherBCBS
NC5908772Medicaid
NC=========YOtherFIRST CAROLINA CARE
NC020CXOtherBCBS
NC=========YOtherFIRST CAROLINA CARE