CAROLINAS PHYSICIANS NETWORK INC

Provider Demographics

• NPI: 1881624807
• Name: CAROLINAS PHYSICIANS NETWORK INC
• Entity type: Organization
• Organization Name: CAROLINAS PHYSICIANS NETWORK INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: ENTERPRISE EVP
• Authorized Official - First Name: SCOTT
• Authorized Official - Last Name: RISSMILLER
• Authorized Official - Phone: 704-355-8675
• Mailing Address - Street 1: PO BOX 19305
• Mailing Address - City: CHARLOTTE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28219-9305
• Mailing Address - Country: US
• Mailing Address - Phone: 704-631-0002
• Practice Address - Street 1: 1237 HARDING PL
• Practice Address - Street 2: STE 3100
• Practice Address - City: CHARLOTTE
• Practice Address - State: NC
• Practice Address - Zip Code: 28204
• Practice Address - Country: US
• Practice Address - Phone: 704-373-0212
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: CAROLINAS PHYSICIANS NETWORK INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-07-04
• Last Update Date: 2023-03-15

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2086S0129X	Allopathic & Osteopathic Physicians	Surgery	Vascular Surgery	Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	133V00000X	Dietary & Nutritional Service Providers	Dietitian, Registered		Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	207RC0001X	Allopathic & Osteopathic Physicians	Internal Medicine	Clinical Cardiac Electrophysiology	Group - Multi-Specialty
No	207RI0011X	Allopathic & Osteopathic Physicians	Internal Medicine	Interventional Cardiology	Group - Multi-Specialty
No	2080P0202X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Cardiology	Group - Multi-Specialty
No	2086S0120X	Allopathic & Osteopathic Physicians	Surgery	Pediatric Surgery	Group - Multi-Specialty
No	208G00000X	Allopathic & Osteopathic Physicians	Thoracic Surgery (Cardiothoracic Vascular Surgery)		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363AS0400X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Surgical	Group - Multi-Specialty
No	363LA2100X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Acute Care	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	5909006	Medicaid
SC	DC9607	Other	RAILROAD MEDICARE
SC	NPB263	Medicaid
NC	5900197	Medicaid
NC	016W3	Other	BLUE CROSS BLUE SHIELD
NC	DC9591	Other	RAILROAD MEDICARE
SC	GPB751	Medicaid
SC	NPB993	Medicaid
NC	1881624807	Medicaid
SC	NPB086	Medicaid
SC	DC9607	Other	RAILROAD MEDICARE
SC	NPB313	Medicaid
NC	5912782	Medicaid
NC	5912675	Medicaid
NC	5900197	Medicaid
NC	GP5032	Medicaid
SC	GPB751	Medicaid