Provider Demographics
NPI:1235475054
Name:CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK, INC.
Other - Org Name:UNION ENDOCRINOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-631-0002
Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-684-0003
Mailing Address - Fax:704-684-0041
Practice Address - Street 1:11304 HAWTHORNE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9425
Practice Address - Country:US
Practice Address - Phone:704-684-0003
Practice Address - Fax:704-684-0041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-26
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5922214Medicaid
NC5922214Medicaid