Provider Demographics
NPI:1194854646
Name:CAROLINA REGIONAL HEART CENTER
Entity Type:Organization
Organization Name:CAROLINA REGIONAL HEART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-878-6904
Mailing Address - Street 1:601 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4331
Mailing Address - Country:US
Mailing Address - Phone:336-878-6904
Mailing Address - Fax:
Practice Address - Street 1:601 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4331
Practice Address - Country:US
Practice Address - Phone:336-878-6904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH POINT REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903473Medicaid
NC5903473Medicaid