Provider Demographics
NPI:1285694471
Name:MECKLENBURG CHEST MEDICINE INC. P.A.
Entity type:Organization
Organization Name:MECKLENBURG CHEST MEDICINE INC. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-342-8140
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-342-8140
Mailing Address - Fax:
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 450
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1114
Practice Address - Country:US
Practice Address - Phone:704-342-8140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88768207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011C1Medicaid
NC207994KMedicare ID - Type Unspecified