Provider Demographics
NPI:1487600813
Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Entity type:Organization
Organization Name:CAROLINAS MEDICAL CENTER-NORTHEAST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:1085 NORTHEAST GATEWAY CT, NE
Mailing Address - Street 2:SUITE 200-A
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2412
Mailing Address - Country:US
Mailing Address - Phone:704-403-8650
Mailing Address - Fax:704-403-8655
Practice Address - Street 1:1085 NORTHEAST GATEWAY CT, NE
Practice Address - Street 2:SUITE 200-A
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2412
Practice Address - Country:US
Practice Address - Phone:704-403-8650
Practice Address - Fax:704-403-8655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS MEDICAL CENTER-NORTHEAST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012HKMedicaid
NCF827OtherPARTNERS MEDICARE CHOICE
NC5906964Medicaid
NCCC2854OtherRAILROAD MEDICARE GROUP
NCDF8926OtherRAILROAD MEDICARE PTAN
NC01058OtherBCBS EFF PRIOR TO 7-1-07
NC019FVOtherBCBS EFF 7-1-07
NC344295OtherMAMSI GROUP NUMBER
NC566000156042OtherTRICARE STANDARD, NON NWK
NC232009Medicare PIN
NC01058OtherBCBS EFF PRIOR TO 7-1-07