Provider Demographics
NPI:1750318101
Name:CAROLINA FAMILY CARE, INC
Entity Type:Organization
Organization Name:CAROLINA FAMILY CARE, INC
Other - Org Name:MUSC PHYSICIANS PCP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-876-1344
Mailing Address - Street 1:PO BOX 602108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2108
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:2125 CHARLIE HALL BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5879
Practice Address - Country:US
Practice Address - Phone:843-571-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC75-17508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1179Medicaid
SCGP1179Medicaid