Provider Demographics
NPI:1124083753
Name:CAROLINA SURGERY AND CANCER CENTER
Entity type:Organization
Organization Name:CAROLINA SURGERY AND CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:HUME
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-485-2707
Mailing Address - Street 1:1501 TATE BLVD SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4243
Mailing Address - Country:US
Mailing Address - Phone:828-485-2707
Mailing Address - Fax:
Practice Address - Street 1:1501 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4243
Practice Address - Country:US
Practice Address - Phone:828-485-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891364MMedicaid
NC8952429Medicaid
NCD17722Medicare UPIN
NC891364MMedicaid
NCH35512Medicare UPIN
NC2217646CMedicare ID - Type UnspecifiedINDIVIDUAL