Provider Demographics
NPI:1023078854
Name:HOLISTIC MEDICAL CLINIC OF THE CAROLINAS LLC
Entity type:Organization
Organization Name:HOLISTIC MEDICAL CLINIC OF THE CAROLINAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:APGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:336-838-7490
Mailing Address - Street 1:PO BOX 1112
Mailing Address - Street 2:
Mailing Address - City:MORAVIAN FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28654-1112
Mailing Address - Country:US
Mailing Address - Phone:336-838-7490
Mailing Address - Fax:336-667-4488
Practice Address - Street 1:308 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2504
Practice Address - Country:US
Practice Address - Phone:336-838-7490
Practice Address - Fax:336-667-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339700Medicare PIN