Provider Demographics
NPI:1154305704
Name:CAROLINA HEART PHYSICIANS PLLC
Entity Type:Organization
Organization Name:CAROLINA HEART PHYSICIANS PLLC
Other - Org Name:CAROLINA HEART PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:KAETTA
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-0018
Mailing Address - Street 1:909 S MCPHERSON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5350
Mailing Address - Country:US
Mailing Address - Phone:910-483-0018
Mailing Address - Fax:910-483-0991
Practice Address - Street 1:909 S MCPHERSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5350
Practice Address - Country:US
Practice Address - Phone:910-483-0018
Practice Address - Fax:910-483-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128AAMedicaid
2335713Medicare ID - Type Unspecified