MEDICARE: DR. CARLOS X PIMENTEL MD

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	207RC0000X	Cardiovascular Disease Physician	J8088	TX
2	207RI0011X	Interventional Cardiology Physician	2021-01859	NC
3	207RI0011X	Interventional Cardiology Physician	J8088	TX
4	207RC0000X	Cardiovascular Disease Physician	2021-01859	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	060036091	OTHER	TX	MEDICARE RAILROAD

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
3	80E929	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1467457879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS X PIMENTEL MD

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-277-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	186 KIMEL PARK DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6946
Country	:	US
Telephone Number	:	336-277-2000
Fax Number	:	336-277-2050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	01/20/2022

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1922091339 — MARK ANDREW HNILICA MD
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1275516429 — TERESA ELAINE MURRELL OTR
Practice Location Address:

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1154309359 — DR. ROBERT SCOTT ALLEN MD
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1487633483 — LAURA C BENNETT PA
Practice Location Address:

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Practice Phone: 336-277-2000
Practice Fax: 336-277-2050

Directions to “ DR. CARLOS X PIMENTEL MD” Practice Location

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