Provider Demographics
NPI:1649219726
Name:CMC-NORTHEAST, INC.
Entity Type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:NORTHEAST INPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:920 CHURCH ST N
Mailing Address - Street 2:NORTHEAST INPATIENT SERVICES
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2927
Mailing Address - Country:US
Mailing Address - Phone:704-403-1331
Mailing Address - Fax:704-403-2533
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:NORTHEAST INPATIENT SERVICES
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1331
Practice Address - Fax:704-403-2533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC125262OtherWELLPATH GROUP
NC566000156002OtherTRICARE STANDARD, NON NWK
NC5906851Medicaid
NCCC2854OtherRAILROAD MEDICARE
NC019G7OtherBCBS EFF 7-1-07
NC2114736OtherMAMSI
NC7234OtherPARTNERS MEDICARE CHOICE
NC890160YMedicaid
NC0160YOtherBCBS EFF PRIOR TO 7-1-07
NCDF8926OtherRAILROAD MEDICARE PTAN
NC566000156002OtherTRICARE STANDARD, NON NWK
NCCC2854OtherRAILROAD MEDICARE
NC7234OtherPARTNERS MEDICARE CHOICE