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General NPI Number Information
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NPI Number | 1346529500
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Entity Type | Organization
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Legal Business Name | CAROLINA MEDICORP ENTERPRISES,INC
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 9600 E INDEPENDENCE BLVD STE 170
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City | MATTHEWS
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State | NC
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Zip | 28105-4628
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Country | US
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Telephone | 704-384-8441
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Fax | 704-384-8442
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Provider Business Mailing Address
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Address Line | PO BOX 751803
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City | CHARLOTTE
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State | NC
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Zip | 28275-1803
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Country | US
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Telephone | 704-384-8441
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Fax | 704-384-8442
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Authorized Official
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Title or Position | VP FINANCE
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Name | GEOFFREY GARDNER
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Credential |
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Telephone | 704-384-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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