MEDICARE: UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1134209760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

Provider Business Mailing Address
First Line	:	143 W FRANKLIN ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-2539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 BROWNING PL
Second Line	:	SUITE 103
City	:	RALEIGH
State	:	NC
Zip	:	27609-6510
Country	:	US
Telephone Number	:	919-843-4810
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. KEITH GRAN
Credential	:
Telephone Number	:	919-843-4810

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/23/2008

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