Provider Demographics
NPI:1770859126
Name:CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY
Other - Org Name:LEVINE CANCER INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-212-1000
Mailing Address - Street 1:PO BOX 602120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2120
Mailing Address - Country:US
Mailing Address - Phone:704-302-8500
Mailing Address - Fax:704-302-8501
Practice Address - Street 1:332 SAM NEWELL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6566
Practice Address - Country:US
Practice Address - Phone:704-302-8500
Practice Address - Fax:704-302-8501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-30
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB470Medicaid
NC5919627Medicaid