Provider Demographics
NPI:1659746576
Name:CAROLINA MEDICORP ENTERPRISES INC
Entity Type:Organization
Organization Name:CAROLINA MEDICORP ENTERPRISES INC
Other - Org Name:NOVANT HEALTH EXPRESS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-481-1970
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-481-1970
Mailing Address - Fax:336-884-5012
Practice Address - Street 1:2620 N MAIN STREET
Practice Address - Street 2:SUITE 109
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2735
Practice Address - Country:US
Practice Address - Phone:336-481-1970
Practice Address - Fax:336-884-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty