Provider Demographics
NPI:1609328210
Name:CAREATC-WHITEHALL
Entity Type:Organization
Organization Name:CAREATC-WHITEHALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PURCHASING AND FACILITIES
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:3615 WHITEHALL PARK DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4138
Mailing Address - Country:US
Mailing Address - Phone:800-993-8244
Mailing Address - Fax:
Practice Address - Street 1:3615 WHITEHALL PARK DR
Practice Address - Street 2:SUITE G
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4138
Practice Address - Country:US
Practice Address - Phone:800-993-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care