Provider Demographics
NPI:1639194574
Name:WHITEVILLE CARDIOPULMONARY INC
Entity Type:Organization
Organization Name:WHITEVILLE CARDIOPULMONARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOBHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-642-4711
Mailing Address - Street 1:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-1354
Mailing Address - Country:US
Mailing Address - Phone:910-642-4711
Mailing Address - Fax:910-642-3232
Practice Address - Street 1:329 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3601
Practice Address - Country:US
Practice Address - Phone:910-642-4711
Practice Address - Fax:910-642-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931148Medicaid
NC31148OtherBCBS OF NC
NC2347794Medicare PIN
NCC81611Medicare UPIN