MEDICARE: CAROLINAS PHYSICIANS NETWORK INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251P0200X	Pediatric Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225XP0200X	Pediatric Occupational Therapist
4	2088P0231X	Pediatric Urology Physician

General Provider Information

NPI Number	:	1356880801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS PHYSICIANS NETWORK INC

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:	704-631-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 MOREHEAD MEDICAL DR
Second Line	:	STE 275
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2963
Country	:	US
Telephone Number	:	704-446-5070
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT RISSMILLER
Credential	:
Telephone Number	:	704-631-0002

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	06/16/2026

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