Provider Demographics
NPI:1467482695
Name:GREATER CAROLINAS WOMENS CENTER, A DIVISION OF WOMENS CARE, P. A.
Entity Type:Organization
Organization Name:GREATER CAROLINAS WOMENS CENTER, A DIVISION OF WOMENS CARE, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOESEL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:704-547-0858
Mailing Address - Street 1:101 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE 2320
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3485
Mailing Address - Country:US
Mailing Address - Phone:704-547-0858
Mailing Address - Fax:704-547-9053
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 2320
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-547-0858
Practice Address - Fax:704-547-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC87133Medicare UPIN
NC211499Medicare ID - Type Unspecified