Provider Demographics
NPI:1710388764
Name:MID CAROLINA OB/GYN
Entity Type:Organization
Organization Name:MID CAROLINA OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:1501 YAMATO RD
Mailing Address - Street 2:SUITE 200 WEST
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4438
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:561-953-4146
Practice Address - Street 1:4414 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7514
Practice Address - Country:US
Practice Address - Phone:919-781-5510
Practice Address - Fax:919-781-5053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UWH OF NORTH CAROLINA LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty