Provider Demographics
NPI:1912323189
Name:CARTERET SURGICAL ASSOCIATES P.A.
Entity Type:Organization
Organization Name:CARTERET SURGICAL ASSOCIATES P.A.
Other - Org Name:CAROLINAS CENTER FOR INTERVENTIONAL PAIN MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-222-5877
Mailing Address - Street 1:534 N 35TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3182
Mailing Address - Country:US
Mailing Address - Phone:252-773-0617
Mailing Address - Fax:252-726-1805
Practice Address - Street 1:534 N 35TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3182
Practice Address - Country:US
Practice Address - Phone:252-773-0614
Practice Address - Fax:252-773-0617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARTERET SURGICAL ASSOCIATES P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-12
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919028Medicaid
NC0537Medicare PIN