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General NPI Number Information
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NPI Number | 1821059650
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Entity Type | Organization
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Legal Business Name | POLYCLINIC MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 9705 NORTHEAST PKWY STE 400
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City | MATTHEWS
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State | NC
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Zip | 28105-9704
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Country | US
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Telephone | 704-844-8971
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Fax | 704-844-8972
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Provider Business Mailing Address
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Address Line | 9705 NORTHEAST PKWY STE 400
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City | MATTHEWS
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State | NC
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Zip | 28105-9704
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Country | US
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Telephone | 704-844-8971
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Fax | 704-844-8972
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Authorized Official
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Title or Position | CEO
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Name | MRS. JOSI BRAZ GARUBA
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Credential |
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Telephone | 704-844-8971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25646
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 2000-01378
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License Number State | NC
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