Provider Demographics
NPI:1104047877
Name:CAROLINA CENTER FOR INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:CAROLINA CENTER FOR INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PILGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-571-4391
Mailing Address - Street 1:4505 FAIR MEADOWS LN
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6465
Mailing Address - Country:US
Mailing Address - Phone:919-571-4391
Mailing Address - Fax:919-571-8968
Practice Address - Street 1:4505 FAIR MEADOWS LN
Practice Address - Street 2:SUITE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6465
Practice Address - Country:US
Practice Address - Phone:919-571-4391
Practice Address - Fax:919-571-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC316142083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC87624Medicare UPIN