MEDICARE: CAROLINA DIAGNOSTICS 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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00391188	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12467	OTHER	NC	BCBS PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407808389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	200 CORPORATE PL
Second Line	:
City	:	PEABODY
State	:	MA
Zip	:	01960-3840
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:	978-535-9757

Provider Business Practice Location Address
First Line	:	119 KANDEMOR LN
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-3212
Country	:	US
Telephone Number	:	252-937-6692
Fax Number	:	252-937-6697

Authorized Official
Title or Position	:	EVP-CFO
Name	:	MR. CARL IBERGER
Credential	:
Telephone Number	:	978-536-6105

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/27/2014

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Directions to “CAROLINA DIAGNOSTICS INC ” Practice Location

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