Healthcare Provider Details

I. General information

NPI: 1154389088
Provider Name (Legal Business Name): CAROLINA MEDICORP ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 HIGH POINT RD DBA PRIMECARE GREENSBORO
GREENSBORO NC
27407-4649
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 200 (ATTN) FORSYTH MEDICAL GROUP
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 336-852-7530
  • Fax: 336-854-9682
Mailing address:
  • Phone: 336-277-2435
  • Fax: 336-277-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAUL M. BARRY
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 336-774-0040