Provider Demographics
NPI:1619609732
Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP & CHIEF PHYSICIAN EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-446-3507
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:704-337-2220
Mailing Address - Fax:
Practice Address - Street 1:2322 WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2448
Practice Address - Country:US
Practice Address - Phone:704-337-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty