MEDICARE: CAROLINA COMPREHENSIVE HEALTH

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	261QU0200X	Urgent Care Clinic/Center	0010-04910	NC

General Provider Information

NPI Number	:	1922414754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA COMPREHENSIVE HEALTH

Provider Business Mailing Address
First Line	:	4654 LONG BEACH RD SE
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8799
Country	:	US
Telephone Number	:	910-457-9564
Fax Number	:	910-457-6744

Provider Business Practice Location Address
First Line	:	4654 LONG BEACH RD SE
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-8799
Country	:	US
Telephone Number	:	910-457-9564
Fax Number	:	910-457-6744

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DEBBIE EVANS
Credential	:
Telephone Number	:	910-457-9564

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	07/01/2014

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