Provider Demographics
NPI:1427081173
Name:MED CARE OF NORTH CAROLINA PLLC
Entity type:Organization
Organization Name:MED CARE OF NORTH CAROLINA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-392-7806
Mailing Address - Street 1:5245 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2209
Mailing Address - Country:US
Mailing Address - Phone:910-392-7806
Mailing Address - Fax:910-392-2428
Practice Address - Street 1:5245 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2209
Practice Address - Country:US
Practice Address - Phone:910-392-7806
Practice Address - Fax:910-392-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCH6587OtherRAILROAD MEDICARE
NC89011X4Medicaid
4082940001Medicare NSC
NC89011X4Medicaid