Provider Demographics
NPI:1437373578
Name:CARDINAL CLINIC, LLC
Entity Type:Organization
Organization Name:CARDINAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:910-222-6234
Mailing Address - Street 1:1540 PURDUE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5510
Mailing Address - Country:US
Mailing Address - Phone:910-867-8889
Mailing Address - Fax:910-487-3061
Practice Address - Street 1:1540 PURDUE DR STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5510
Practice Address - Country:US
Practice Address - Phone:910-867-8889
Practice Address - Fax:910-487-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900672Medicaid