Healthcare Provider Details

I. General information

NPI: 1174559504
Provider Name (Legal Business Name): CHARLOTTE-MECKLENBURG HEALTH SERVICES FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

PO BOX 32861
CHARLOTTE NC
28232-2861
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-2000
  • Fax: 704-355-5073
Mailing address:
  • Phone: 704-512-6438
  • Fax: 704-512-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIE UNDERWOOD
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-355-3147