Provider Demographics
NPI:1063584415
Name:CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA
Entity type:Organization
Organization Name:CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-372-7974
Mailing Address - Street 1:PO BOX 96314
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28296-0314
Mailing Address - Country:US
Mailing Address - Phone:704-372-7974
Mailing Address - Fax:704-970-4746
Practice Address - Street 1:300 BILLINGSLEY ROAD
Practice Address - Street 2:SUITE 200B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3092
Practice Address - Country:US
Practice Address - Phone:704-372-7974
Practice Address - Fax:704-372-4966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23881097COtherMEDICARE PIN