Provider Demographics
NPI:1407066699
Name:CAROLINA HEART CARE, PA
Entity Type:Organization
Organization Name:CAROLINA HEART CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:336-386-4477
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017-0920
Mailing Address - Country:US
Mailing Address - Phone:336-386-4477
Mailing Address - Fax:336-386-8005
Practice Address - Street 1:306 S. WHITE STREET
Practice Address - Street 2:UNIT 1
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8938
Practice Address - Country:US
Practice Address - Phone:336-386-4477
Practice Address - Fax:336-386-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC129464207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901096Medicaid
NC2402592Medicare ID - Type Unspecified
NCH12701Medicare UPIN