Provider Demographics
NPI:1699900696
Name:DLP CENTRAL CAROLINA MEDICAL CENTER LLC
Entity type:Organization
Organization Name:DLP CENTRAL CAROLINA MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:GIOVANETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:1135 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4162
Practice Address - Country:US
Practice Address - Phone:919-774-2100
Practice Address - Fax:919-708-4628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLP CENTRAL CAROLINA MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-19
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0243341600000X
3416A0800X, 3416L0300X, 3416S0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
No3416S0300XTransportation ServicesAmbulanceWater Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406692Medicaid
NC34002Medicare PIN