Provider Demographics
NPI:1164675914
Name:METROLINA AIDS PROJECT, INC.
Entity Type:Organization
Organization Name:METROLINA AIDS PROJECT, INC.
Other - Org Name:METROLINA CARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-333-1435
Mailing Address - Street 1:PO BOX 32662
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2662
Mailing Address - Country:US
Mailing Address - Phone:704-333-1435
Mailing Address - Fax:704-602-2440
Practice Address - Street 1:5801 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 114
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8861
Practice Address - Country:US
Practice Address - Phone:704-936-4460
Practice Address - Fax:704-936-4470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROLINA AIDS PROJECT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-24
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
2335882OtherMEDICARE PTAN