Provider Demographics
NPI:1629143524
Name:CAROLINA MOUNTAIN EMERGENCY MEDICINE PA
Entity Type:Organization
Organization Name:CAROLINA MOUNTAIN EMERGENCY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POORBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-627-5670
Mailing Address - Street 1:PO BOX 1856
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-1856
Mailing Address - Country:US
Mailing Address - Phone:843-237-3378
Mailing Address - Fax:843-237-5073
Practice Address - Street 1:ANGEL MEDICAL CENTER
Practice Address - Street 2:RIVERVIEW AND WHITE OAK ST
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-2612
Practice Address - Country:US
Practice Address - Phone:843-237-3378
Practice Address - Fax:843-237-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQPB951Medicaid
NC01036OtherBCBS
NC5902361Medicaid
NCCD1694OtherRAILROAD MEDICARE
NCCD1694OtherRAILROAD MEDICARE