Provider Demographics
NPI:1922455518
Name:CAROLINA ONCOLOGY SPECIALISTS, PA
Entity Type:Organization
Organization Name:CAROLINA ONCOLOGY SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-324-9550
Mailing Address - Street 1:2406 CENTURY PLACE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603
Mailing Address - Country:US
Mailing Address - Phone:828-324-9550
Mailing Address - Fax:828-324-4154
Practice Address - Street 1:2406 CENTURY PLACE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28603
Practice Address - Country:US
Practice Address - Phone:828-324-9550
Practice Address - Fax:828-324-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40721261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC032110OtherBCBSNC GROUP #
NC209332EOtherMEDICARE PTAN
NC5921918Medicaid