Provider Demographics
NPI:1639300056
Name:CAROLINAS COMPLETE CARE FOR WOMEN
Entity Type:Organization
Organization Name:CAROLINAS COMPLETE CARE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-286-5400
Mailing Address - Street 1:900 E SUNSET DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5893
Mailing Address - Country:US
Mailing Address - Phone:803-286-5400
Mailing Address - Fax:803-286-5488
Practice Address - Street 1:900 E SUNSET DR
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5893
Practice Address - Country:US
Practice Address - Phone:803-286-5400
Practice Address - Fax:803-286-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E56623Medicare UPIN