Provider Demographics
NPI:1689620957
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:KANNAPOLIS INTERNAL MEDICINE
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 1:201 DALE EARNHARDT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-0303
Mailing Address - Country:US
Mailing Address - Phone:704-932-1155
Mailing Address - Fax:704-932-3500
Practice Address - Street 1:201 DALE EARNHARDT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-0303
Practice Address - Country:US
Practice Address - Phone:704-932-1155
Practice Address - Fax:704-932-3500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0116MOtherBCBS EFF PRIOR TO 7-1-07
NC566000156011OtherTRICARE STANDARD, NON NWK
NCCC2854OtherRAILROAD MEDICARE GROUP
NC890116MMedicaid
NC5906968Medicaid
NC7231OtherPARTNERS MEDICARE CHOICE
NCDF8926OtherRAILROAD MEDICARE PTAN
NC019F3OtherBCBS EFF 7-1-07
NC355573OtherMAMSI GROUP NO
NCDF8926OtherRAILROAD MEDICARE PTAN
NCCC2854OtherRAILROAD MEDICARE GROUP
NC355573OtherMAMSI GROUP NO