Provider Demographics
NPI:1417399403
Name:CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK, INC.
Other - Org Name:FOOTHILLS FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FORD
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-631-0002
Mailing Address - Street 1:PO BOX 601884
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1884
Mailing Address - Country:US
Mailing Address - Phone:828-245-3158
Mailing Address - Fax:828-247-6484
Practice Address - Street 1:249 OAK ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3585
Practice Address - Country:US
Practice Address - Phone:828-245-3158
Practice Address - Fax:828-247-6484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-19
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417399403Medicaid
NC5913096Medicaid
SCNPB837Medicaid
NC2331634AMedicare PIN
NC5913096Medicaid