Provider Demographics
NPI:1558300566
Name:CMC-NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:PIEDMONT PEDIATRICS
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 1:1085 NE GATEWAY CT
Mailing Address - Street 2:SUITE 290, PIEDMONT PEDIATRICS
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2406
Mailing Address - Country:US
Mailing Address - Phone:704-403-4650
Mailing Address - Fax:704-403-4656
Practice Address - Street 1:1085 NE GATEWAY CT
Practice Address - Street 2:SUITE 290, PIEDMONT PEDIATRICS
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2406
Practice Address - Country:US
Practice Address - Phone:704-403-4650
Practice Address - Fax:704-403-4656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC566000156045OtherTRICARE STANDARD, NON NWK
NC02233OtherBCBS EFF PRIOR TO 7-1-07
NC89012YJMedicaid
NCDF8926OtherRAILROAD MEDICARE PTAN
NC355573OtherMAMSI
NCCC2854OtherRAILROAD MEDICARE
NC019GKOtherBCBS EFF 7-1-07
NC5906965Medicaid
NCG708OtherPARTNERS MEDICARE CHOICE