MEDICARE: HOSPICE & PALLIATIVE CARE CHARLOTTE REGION

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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417570771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE & PALLIATIVE CARE CHARLOTTE REGION

Provider Business Mailing Address
First Line	:	PO BOX 470408
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28247-0408
Country	:	US
Telephone Number	:	704-375-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 RED VENTURES DR STE 130
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-2516
Country	:	US
Telephone Number	:	803-548-3708
Fax Number	:	803-431-2249

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	PETER A BRUNNICK
Credential	:
Telephone Number	:	704-335-3501

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	04/24/2025

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