Provider Demographics
NPI:1265434039
Name:CAROLINA CANCER SPECIALISTS, PA
Entity type:Organization
Organization Name:CAROLINA CANCER SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-454-0181
Mailing Address - Street 1:600 HOSPITAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8046
Mailing Address - Country:US
Mailing Address - Phone:828-454-0181
Mailing Address - Fax:828-454-0584
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8046
Practice Address - Country:US
Practice Address - Phone:828-454-0181
Practice Address - Fax:828-454-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011THOtherBC/BS NC GROUP NUMBER
NC3670294OtherUHC
NC89011THMedicaid
NCCB3766OtherMEDICARE RR
NC=========OtherTRICARE
NC011THOtherBC/BS NC GROUP NUMBER
NC2344708Medicare ID - Type UnspecifiedMEDICARE GROUP
NCCB3766OtherMEDICARE RR