Provider Demographics
NPI:1861667388
Name:CABARRUS PEDIATRIC PRACTICE, INC.
Entity Type:Organization
Organization Name:CABARRUS PEDIATRIC PRACTICE, INC.
Other - Org Name:CABARRUS PEDIATRICS - KANNAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-2276
Mailing Address - Street 1:201 DALE EARNHARDT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-0303
Mailing Address - Country:US
Mailing Address - Phone:704-403-7735
Mailing Address - Fax:704-932-0270
Practice Address - Street 1:201 DALE EARNHARDT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-0303
Practice Address - Country:US
Practice Address - Phone:704-403-7735
Practice Address - Fax:704-932-0270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABARRUS PEDIATRIC PRACTICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0205UOtherBCBS NC
NC5950224OtherCAROLINA ACCESS
NC5950224Medicaid