Healthcare Provider Details

I. General information

NPI: 1497148506
Provider Name (Legal Business Name): CAROLINA MEDICORP ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 JAKE ALEXANDER BLVD W
SALISBURY NC
28147-1178
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-1551
  • Fax: 704-638-1553
Mailing address:
  • Phone: 704-384-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY K GARDNER
Title or Position: VP FINANCE
Credential:
Phone: 704-384-7603