Provider Demographics
NPI:1477569820
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:NORTHEAST WOMEN'S HEALTH & OBSTETRICS AT RENAISSANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:2101 SHILOH CHURCH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7603
Mailing Address - Country:US
Mailing Address - Phone:704-439-3770
Mailing Address - Fax:704-439-3779
Practice Address - Street 1:2101 SHILOH CHURCH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7603
Practice Address - Country:US
Practice Address - Phone:704-439-3770
Practice Address - Fax:704-439-3779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCK076OtherPARTNERS MEDICARE CHOICE
NC019F4OtherBCBS EFF 7-1-07
NC5903802Medicaid
NC5906959Medicaid
NCCC2854OtherRAILROAD MEDICARE
NC566000156079OtherTRICARE
NCDF8926OtherRAILROAD MEDICARE PTAN
NC355573OtherMAMSI
NC018FNOtherBCBS GROUP ID
NCDF8926OtherRAILROAD MEDICARE PTAN
NCCC2854OtherRAILROAD MEDICARE
NC355573OtherMAMSI