MEDICARE: MID-CAROLINA HOMECARE SPECIALISTS

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	251F00000X	Home Infusion Agency	HC1801	NC
2	333600000X	Pharmacy	07363	NC
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	HC1801	NC
4	332B00000X	Durable Medical Equipment & Medical Supplies	HC1801	NC
5	332BX2000X	Oxygen Equipment & Supplies (DME)	07363	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	04380	OTHER	NC	BC/BS OF NC HOME INFUSION
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0448V	OTHER	NC	BC/BS OF NC DME

General Provider Information

NPI Number	:	1659379972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-CAROLINA HOMECARE SPECIALISTS

Provider Business Mailing Address
First Line	:	600 AIRPORT BLVD
Second Line	:	SUITE 500
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8489
Country	:	US
Telephone Number	:	919-465-9300
Fax Number	:	919-465-9310

Provider Business Practice Location Address
First Line	:	600 AIRPORT BLVD
Second Line	:	SUITE 500
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8489
Country	:	US
Telephone Number	:	919-465-9300
Fax Number	:	919-465-9310

Authorized Official
Title or Position	:	REIMBURSEMENT MANAGER
Name	:	DESIREE MCCULLOUGH
Credential	:	MBA
Telephone Number	:	919-465-9300

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	09/11/2025

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