Healthcare Provider Details

I. General information

NPI: 1912338328
Provider Name (Legal Business Name): ONSITE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 PERIMETER PKWY SUITE 200
CHARLOTTE NC
28216-2447
US

IV. Provider business mailing address

10130 PERIMETER PKWY STE 200
CHARLOTTE NC
28216-0197
US

V. Phone/Fax

Practice location:
  • Phone: 888-849-7379
  • Fax:
Mailing address:
  • Phone: 888-849-7379
  • Fax: 855-857-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2960
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9701437
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number2011-00546
License Number StateNC

VIII. Authorized Official

Name: DR. WILLIAM SAMPSON
Title or Position: MANAGING PARTNER
Credential: PH.D.
Phone: 919-630-5171