Provider Demographics
NPI:1659379972
Name:MID-CAROLINA HOMECARE SPECIALISTS
Entity Type:Organization
Organization Name:MID-CAROLINA HOMECARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:919-465-9300
Mailing Address - Street 1:600 AIRPORT BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8489
Mailing Address - Country:US
Mailing Address - Phone:919-465-9300
Mailing Address - Fax:919-465-9310
Practice Address - Street 1:600 AIRPORT BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-8489
Practice Address - Country:US
Practice Address - Phone:919-465-9300
Practice Address - Fax:919-465-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1801251F00000X, 332B00000X, 332BP3500X
NC07363332BX2000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251F00000XAgenciesHome Infusion
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6800414Medicaid
NC7703063Medicaid
NC04380OtherBC/BS OF NC HOME INFUSION
NC0920077Medicaid
NC0448VOtherBC/BS OF NC DME
NC04380OtherBC/BS OF NC HOME INFUSION