MEDICARE: GREATER CHARLOTTE SUPPORT SERVICES, PLLC

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	207L00000X	Anesthesiology Physician
2	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1598625626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER CHARLOTTE SUPPORT SERVICES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 739937
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-9937
Country	:	US
Telephone Number	:	425-803-3885
Fax Number	:	866-665-8561

Provider Business Practice Location Address
First Line	:	300 BILLINGSLEY RD STE 200-B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1075
Country	:	US
Telephone Number	:	704-927-6066
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JAMES KREGER
Credential	:
Telephone Number	:	502-418-4700

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	12/23/2025

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