Provider Demographics
NPI:1376505990
Name:THE CAROLINA CENTER FOR RHEUMATOLOGY AND ARTHRITIS CARE, PA
Entity Type:Organization
Organization Name:THE CAROLINA CENTER FOR RHEUMATOLOGY AND ARTHRITIS CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:PATRONIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-329-1660
Mailing Address - Street 1:744 ARDEN LANE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2984
Mailing Address - Country:US
Mailing Address - Phone:803-329-1660
Mailing Address - Fax:803-329-4118
Practice Address - Street 1:744 ARDEN LN
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3286
Practice Address - Country:US
Practice Address - Phone:803-329-1660
Practice Address - Fax:803-329-4118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14896174400000X
SC17962174400000X
NC39768174400000X
NC01456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCC6002Medicaid
SC=========OtherEIN
SCCC6002Medicaid
SCCC6002Medicaid
NC2318671Medicare PIN