Provider Demographics
NPI:1912416231
Name:CAROLINA INTERNAL MEDICINE ASSOCIATES, PA
Entity Type:Organization
Organization Name:CAROLINA INTERNAL MEDICINE ASSOCIATES, PA
Other - Org Name:TIMSHEL MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-258-0397
Mailing Address - Street 1:20 S MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4972
Mailing Address - Country:US
Mailing Address - Phone:828-258-0397
Mailing Address - Fax:828-258-3390
Practice Address - Street 1:20 S MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4972
Practice Address - Country:US
Practice Address - Phone:828-258-0397
Practice Address - Fax:828-258-3390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA INTERNAL MEDICINE ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty