Provider Demographics
NPI:1780270744
Name:CAROLINA PEDIATRICS AT ROCK HILL LLC
Entity type:Organization
Organization Name:CAROLINA PEDIATRICS AT ROCK HILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAXTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-327-9999
Mailing Address - Street 1:225 HERLONG AVE S STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2168
Mailing Address - Country:US
Mailing Address - Phone:803-327-9999
Mailing Address - Fax:803-327-9998
Practice Address - Street 1:225 HERLONG AVE S STE 201
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2168
Practice Address - Country:US
Practice Address - Phone:803-327-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPG0184Medicaid