Provider Demographics
NPI:1710150610
Name:KANE INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:KANE INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-367-4373
Mailing Address - Street 1:7257 PINEVILLE MATTHEWS RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6183
Mailing Address - Country:US
Mailing Address - Phone:704-367-4373
Mailing Address - Fax:704-367-7842
Practice Address - Street 1:7257 PINEVILLE MATTHEWS RD STE 1200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6183
Practice Address - Country:US
Practice Address - Phone:704-367-4373
Practice Address - Fax:704-367-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891254LMedicaid
NCH22669Medicare UPIN
NC891254LMedicaid