Provider Demographics
NPI:1629469663
Name:CAROLINAS-ANSON HEALTHCARE, INC.
Entity Type:Organization
Organization Name:CAROLINAS-ANSON HEALTHCARE, INC.
Other - Org Name:CAROLINAS HEALTHCARE SYSTEM ANSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF SOUTH EASTERN DIVISION
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-993-4057
Mailing Address - Street 1:2301 US HIGHWAY 74 W
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-7554
Mailing Address - Country:US
Mailing Address - Phone:704-994-4500
Mailing Address - Fax:704-994-4511
Practice Address - Street 1:2301 US HIGHWAY 74 W
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-7554
Practice Address - Country:US
Practice Address - Phone:704-994-4500
Practice Address - Fax:704-994-4511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-12
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E604Medicare PIN