Provider Demographics
NPI:1740329796
Name:HIGH POINT REGIONAL CLINIC
Entity type:Organization
Organization Name:HIGH POINT REGIONAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHRM MANG
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-878-6033
Mailing Address - Street 1:624 QUAKER LN STE 301D
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:624 QUAKER LN STE 301D
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3800
Practice Address - Country:US
Practice Address - Phone:336-844-6033
Practice Address - Fax:336-878-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43653336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3428972OtherOTHER ID NUMBER
3428972OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC0417071Medicaid