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
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1548274327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA MEDICORP ENTERPRISES INC

Provider Business Mailing Address
First Line	:	2000 FRONTIS PLAZA BLVD STE 102
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5616
Country	:	US
Telephone Number	:	336-718-4820
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 FRONTIS PLAZA BLVD STE 200
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5616
Country	:	US
Telephone Number	:	336-277-2435
Fax Number	:	336-277-9275

Authorized Official
Title or Position	:	VP OPERATIONS
Name	:	MICHELE GRIER
Credential	:
Telephone Number	:	336-472-1191

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/14/2008

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