Provider Demographics
NPI:1568873198
Name:BARIATRIC SPECIALISTS OF NORTH CAROLINA
Entity Type:Organization
Organization Name:BARIATRIC SPECIALISTS OF NORTH CAROLINA
Other - Org Name:MACGREGOR SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALVA
Authorized Official - Last Name:DIMMIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-220-5255
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:160 MACGREGOR PINES DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6036
Practice Address - Country:US
Practice Address - Phone:919-234-4468
Practice Address - Fax:877-827-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39442208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02837OtherBCBSNC