MEDICARE: CABARRUS ROWAN COMMUNITY HEALTH CENTERS, 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	207Q00000X	Family Medicine Physician
2	261QF0400X	Federally Qualified Health Center (FQHC)

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689870941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABARRUS ROWAN COMMUNITY HEALTH CENTERS, INC.

Provider Business Mailing Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:	704-920-1065
Fax Number	:	704-792-2272

Provider Business Practice Location Address
First Line	:	298 LINCOLN ST SW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-5469
Country	:	US
Telephone Number	:	704-920-1065
Fax Number	:	704-792-2272

Authorized Official
Title or Position	:	CEO
Name	:	MR. DON HOLLOMAN
Credential	:
Telephone Number	:	704-792-2203

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	10/07/2022

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