Healthcare Provider Details

I. General information

NPI: 1255501235
Provider Name (Legal Business Name): CAROLINAS HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-1210
  • Fax: 704-355-1221
Mailing address:
  • Phone: 704-355-1210
  • Fax: 704-355-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number127962
License Number StateNC

VIII. Authorized Official

Name: MRS. KELLY HOWELL CALHOUN
Title or Position: NNP
Credential: RNC, MSN
Phone: 704-355-3339