Provider Demographics
NPI:1023238490
Name:CAROLINAS MEDICAL ALLIANCE, INC
Entity type:Organization
Organization Name:CAROLINAS MEDICAL ALLIANCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-628-6038
Mailing Address - Street 1:953 S. PAMPLICO HWY.
Mailing Address - Street 2:
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583-4058
Mailing Address - Country:US
Mailing Address - Phone:843-493-5252
Mailing Address - Fax:843-493-2372
Practice Address - Street 1:953 S. PAMPLICO HWY.
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583-4058
Practice Address - Country:US
Practice Address - Phone:843-493-5252
Practice Address - Fax:843-493-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC109Medicaid
SC428940Medicare Oscar/Certification