Provider Demographics
NPI:1841341278
Name:CAROLINA CARDIOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:CAROLINA CARDIOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:'ZAN'
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:336-629-4176
Mailing Address - Street 1:306 WESTWOOD AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4341
Mailing Address - Country:US
Mailing Address - Phone:336-629-4176
Mailing Address - Fax:336-626-6604
Practice Address - Street 1:542 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4710
Practice Address - Country:US
Practice Address - Phone:336-629-4176
Practice Address - Fax:336-626-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901831Medicaid
NC0366Medicare UPIN