MEDICARE: CAROLINA CARDIOVASCULAR HEALTH & FITNESS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	27167	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1137F	OTHER	NC	BC/BS - EARNHARDT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033164421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CARDIOVASCULAR HEALTH & FITNESS, PA

Provider Business Mailing Address
First Line	:	2800 BLUE RIDGE RD
Second Line	:	SUITE 403
City	:	RALEIGH
State	:	NC
Zip	:	27607-6478
Country	:	US
Telephone Number	:	919-232-0050
Fax Number	:	919-232-0060

Provider Business Practice Location Address
First Line	:	2800 BLUE RIDGE RD
Second Line	:	SUITE 403
City	:	RALEIGH
State	:	NC
Zip	:	27607-6478
Country	:	US
Telephone Number	:	919-232-0050
Fax Number	:	919-232-0060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES WILLIAM EARNHARDT
Credential	:	MD
Telephone Number	:	919-232-0050

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/01/2008

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