Healthcare Provider Details

I. General information

NPI: 1083696926
Provider Name (Legal Business Name): TENET CENTRAL CAROLINA PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 WICKER ST STE B
SANFORD NC
27330-4142
US

IV. Provider business mailing address

PO BOX 741608
ATLANTA GA
30384-1608
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-1277
  • Fax: 919-774-1101
Mailing address:
  • Phone: 919-774-1277
  • Fax: 919-774-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL KYLE BURTNETT
Title or Position: SVP OF OUTPATIENT SERVICES, TENET
Credential:
Phone: 469-893-2153