Provider Demographics
NPI: | 1346673290 |
---|---|
Name: | THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY |
Entity Type: | Organization |
Organization Name: | THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY |
Other - Org Name: | CAROLINAS MEDICAL CENTER-NORTHEAST |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | SR VP |
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: | 704-403-1780 |
Mailing Address - Street 1: | 845 CHURCH ST N |
Mailing Address - Street 2: | SUITE 310 |
Mailing Address - City: | CONCORD |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28025-4375 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-403-2276 |
Mailing Address - Fax: | 704-795-2181 |
Practice Address - Street 1: | 920 CHURCH ST N |
Practice Address - Street 2: | PHYSICIAN NETWORK |
Practice Address - City: | CONCORD |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28025-2927 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-403-1780 |
Practice Address - Fax: | 704-795-2181 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2013-08-14 |
Last Update Date: | 2014-01-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | C904 | Medicare PIN |