MEDICARE: CAROLINA MEDICORP ENTERPRISES, INC.

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	207P00000X	Emergency Medicine Physician		NC

General Provider Information

NPI Number	:	1235643420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA MEDICORP ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7811 N POINT BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3209
Country	:	US
Telephone Number	:	336-759-0700
Fax Number	:

Authorized Official
Title or Position	:	SR. DIRECTOR
Name	:	MARIMARTHA MATTHEWS
Credential	:
Telephone Number	:	704-384-7689

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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