MEDICARE: YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER CHARLOTTE

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1871040691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG MEN'S CHRISTIAN ASSOCIATION OF GREATER CHARLOTTE

Provider Business Mailing Address
First Line	:	400 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2610
Country	:	US
Telephone Number	:	704-716-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E MOREHEAD ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-2610
Country	:	US
Telephone Number	:	704-716-6200
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. TODD TIBBITS
Credential	:
Telephone Number	:	704-716-6060

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	09/09/2016

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