MEDICARE: SOUTHCROSS FAMILY MEDICINE PLLC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1972860310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHCROSS FAMILY MEDICINE PLLC

Provider Business Mailing Address
First Line	:	1341 E MOREHEAD STREET
Second Line	:	101
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-900-5163
Fax Number	:	704-900-5263

Provider Business Practice Location Address
First Line	:	1341 E MOREHEAD STREET
Second Line	:	101
City	:	CHARLOTTE
State	:	NC
Zip	:	28204
Country	:	US
Telephone Number	:	704-900-5163
Fax Number	:	704-900-5263

Authorized Official
Title or Position	:	OWNER
Name	:	AMIR I KALDAS
Credential	:
Telephone Number	:	704-900-5163

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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