Provider Demographics
NPI:1760413355
Name:CAROLINA CENTER FOR PAIN P A
Entity Type:Organization
Organization Name:CAROLINA CENTER FOR PAIN P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-295-3200
Mailing Address - Street 1:293 OLMSTED BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9023
Mailing Address - Country:US
Mailing Address - Phone:910-295-3200
Mailing Address - Fax:910-295-3222
Practice Address - Street 1:293 OLMSTED BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9023
Practice Address - Country:US
Practice Address - Phone:910-295-3200
Practice Address - Fax:910-295-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911783Medicaid
NC011U1OtherBCBS GROUP NUMBER
NC011U1OtherBCBS GROUP NUMBER
NC2344767Medicare ID - Type Unspecified