Provider Demographics
NPI:1275791022
Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Entity Type:Organization
Organization Name:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Other - Org Name:CHAPEL HILL ADULT SICKLE CELL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:AVP - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-966-6862
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 EASTOWNE DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2286
Practice Address - Country:US
Practice Address - Phone:984-974-2695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890282JMedicaid