Provider Demographics
NPI:1205815701
Name:ID CONSULTANTS PA
Entity Type:Organization
Organization Name:ID CONSULTANTS PA
Other - Org Name:ID CONSULTANTS PA & INFUSION CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:704-331-9669
Mailing Address - Street 1:4539 HEDGEMORE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209
Mailing Address - Country:US
Mailing Address - Phone:704-331-9669
Mailing Address - Fax:704-688-0035
Practice Address - Street 1:4539 HEDGEMORE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:704-331-9669
Practice Address - Fax:704-688-0035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ID CONSULTANTS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-12
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890145CMedicaid
SCGP0907Medicaid
SCGP0907Medicaid