Provider Demographics
NPI:1659571610
Name:CAROLINA WOMEN'S HEALTH PAVILION, PA
Entity Type:Organization
Organization Name:CAROLINA WOMEN'S HEALTH PAVILION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:DELORIS
Authorized Official - Last Name:FOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-938-0900
Mailing Address - Street 1:247 MEMORIAL DR
Mailing Address - Street 2:P.O. BOX 12033
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6333
Mailing Address - Country:US
Mailing Address - Phone:910-938-0900
Mailing Address - Fax:910-355-0404
Practice Address - Street 1:247 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6333
Practice Address - Country:US
Practice Address - Phone:910-938-0900
Practice Address - Fax:910-355-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20584207VG0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014NMOtherBCBSNC
NC89014NMMedicaid