Provider Demographics
NPI:1275598690
Name:CONCORD WOMEN'S SPECIALTY CENTER
Entity Type:Organization
Organization Name:CONCORD WOMEN'S SPECIALTY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:RAYMER
Authorized Official - Last Name:MARANGONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-792-1000
Mailing Address - Street 1:200 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2982
Mailing Address - Country:US
Mailing Address - Phone:704-792-1000
Mailing Address - Fax:704-792-1004
Practice Address - Street 1:200 MEDICAL PARK DR
Practice Address - Street 2:SUITE 430
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2982
Practice Address - Country:US
Practice Address - Phone:704-792-1000
Practice Address - Fax:704-792-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0283FOtherBCBS GROUP #
NC890283FMedicaid
NC2315197OtherMEDICARE GROUP
NCCA8448OtherMEDICARE RAILROAD