Provider Demographics
NPI:1427726157
Name:NCCRTEAM
Entity type:Organization
Organization Name:NCCRTEAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-493-1641
Mailing Address - Street 1:1911 SUGARBUSH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-1082
Mailing Address - Country:US
Mailing Address - Phone:704-493-1641
Mailing Address - Fax:
Practice Address - Street 1:1911 SUGARBUSH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-1082
Practice Address - Country:US
Practice Address - Phone:704-493-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251V00000XAgenciesVoluntary or Charitable
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty