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NPI Code Detail

MEDICARE: CAROLINAS PHYSICIANS NETWORK INC

MEDICARE: CAROLINAS PHYSICIANS NETWORK 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
12080P0216XPediatric Rheumatology Physician
2208100000XPhysical Medicine & Rehabilitation Physician
3133N00000XNutritionist
4208C00000XColon & Rectal Surgery Physician
5207RC0000XCardiovascular Disease Physician
6207RB0002XObesity Medicine (Internal Medicine) Physician
7207RR0500XRheumatology Physician

General Provider Information

NPI Number : 1750606174
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINAS PHYSICIANS NETWORK INC
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number : 704-631-0002
Fax Number :
Provider Business Practice Location Address
First Line : 704 GOLD HILL RD
Second Line : STE 203
City : FORT MILL
State : SC
Zip : 29715-8906
Country : US
Telephone Number : 803-835-0400
Fax Number :
Authorized Official
Title or Position : ENTERPRISE EVP
Name : SCOTT RISSMILLER
Credential :
Telephone Number : 704-355-8675
Provider Enumeration Date : 03/29/2010
Last Update Date : 06/12/2026

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