Provider Demographics
NPI:1346432838
Name:CMC-NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:STANLY REGIONAL HOSPITALIST PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:301 YADKIN ST
Mailing Address - Street 2:STANLY REGIONAL HOSPITALIST PHYSICIANS
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3441
Mailing Address - Country:US
Mailing Address - Phone:704-984-4365
Mailing Address - Fax:704-983-7856
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:STANLY REGIONAL HOSPITALIST PHYSICIANS
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4365
Practice Address - Fax:704-983-7856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9523057OtherAETNA
NC019K5OtherBCBS NC
NC5908520Medicaid
NCDF8926OtherRAILROAD MEDICARE PTAN
NCDF8926OtherRAILROAD MEDICARE PTAN
NC232009Medicare PIN