Healthcare Provider Details

I. General information

NPI: 1740465368
Provider Name (Legal Business Name): PRESBYTERIAN REGIONAL HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 E 4TH ST SUITE 501
CHARLOTTE NC
28204-3261
US

IV. Provider business mailing address

1718 E 4TH ST SUITE 501
CHARLOTTE NC
28204-3261
US

V. Phone/Fax

Practice location:
  • Phone: 704-343-9800
  • Fax: 704-347-2011
Mailing address:
  • Phone: 704-343-9800
  • Fax: 704-347-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DINESH S PAI
Title or Position: VP OF OPERATIONS
Credential:
Phone: 704-384-9104