Provider Demographics
NPI:1356400311
Name:ROBERT THOMAS CARPENTER JR.
Entity type:Organization
Organization Name:ROBERT THOMAS CARPENTER JR.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-694-0179
Mailing Address - Street 1:1035 E CASWELL ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2375
Mailing Address - Country:US
Mailing Address - Phone:704-694-0179
Mailing Address - Fax:704-694-0168
Practice Address - Street 1:1035 E CASWELL ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2375
Practice Address - Country:US
Practice Address - Phone:704-694-0179
Practice Address - Fax:704-694-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5651270001Medicare ID - Type Unspecified