Provider Demographics
NPI:1992832869
Name:CAROLINA FAMILY CARE, INC
Entity Type:Organization
Organization Name:CAROLINA FAMILY CARE, INC
Other - Org Name:MUSC PHYSICIANS PCP LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-876-1344
Mailing Address - Street 1:PO BOX 602108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2108
Mailing Address - Country:US
Mailing Address - Phone:843-573-1517
Mailing Address - Fax:
Practice Address - Street 1:1600 MIDTOWN AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3771
Practice Address - Country:US
Practice Address - Phone:843-876-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-17508291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL00125Medicaid
SCL00125Medicaid
SCQ32447Medicare ID - Type Unspecified