Provider Demographics
NPI:1306950530
Name:MIDCAROLINA ENT
Entity type:Organization
Organization Name:MIDCAROLINA ENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-983-5350
Mailing Address - Street 1:1908 HILCO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-6387
Mailing Address - Country:US
Mailing Address - Phone:704-983-5350
Mailing Address - Fax:704-983-5370
Practice Address - Street 1:1908 HILCO ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-6387
Practice Address - Country:US
Practice Address - Phone:704-983-5350
Practice Address - Fax:704-983-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014V0Medicaid
NC89014V0Medicaid