Healthcare Provider Details

I. General information

NPI: 1760810501
Provider Name (Legal Business Name): CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9625 NORTHCROSS CENTER CT SUITE 102
HUNTERSVILLE NC
28078-7348
US

IV. Provider business mailing address

PO BOX 602120
CHARLOTTE NC
28260-2120
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-8840
  • Fax: 704-381-8836
Mailing address:
  • Phone: 704-381-8840
  • Fax: 704-381-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER W ACKER
Title or Position: PRESIDENT/CMC - LINCOLN
Credential:
Phone: 980-212-1000