Provider Demographics
NPI:1952633190
Name:CHARLOTTE MEDICAL CENTER
Entity Type:Organization
Organization Name:CHARLOTTE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:704-355-8983
Mailing Address - Street 1:PO BOX 32861
Mailing Address - Street 2:ANESTHESIA SERVICES, 5TH FLOOR SURGICAL TOWER
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-355-8983
Mailing Address - Fax:704-355-7938
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:ANESTHESIA SERVICES, 5TH FLOOR SURGICAL TOWER
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-8983
Practice Address - Fax:704-355-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty