Provider Demographics
NPI:1528071446
Name:SUGARCREEK MEDICAL CENTER
Entity type:Organization
Organization Name:SUGARCREEK MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IYORE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:OJOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-941-2080
Mailing Address - Street 1:721 W SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6163
Mailing Address - Country:US
Mailing Address - Phone:704-941-2080
Mailing Address - Fax:704-941-2085
Practice Address - Street 1:721 W SUGAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6163
Practice Address - Country:US
Practice Address - Phone:704-941-2080
Practice Address - Fax:704-941-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017KTOtherBLUECROSSBLUESHIELD ID#
NC5902388Medicaid
NC2349096Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID