Provider Demographics
NPI:1730149436
Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:CLEVELAND COUNTY HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CODING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-480-1087
Mailing Address - Street 1:PO BOX 601409
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1409
Mailing Address - Country:US
Mailing Address - Phone:704-480-1087
Mailing Address - Fax:704-484-3260
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:800-513-0025
Practice Address - Fax:919-477-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0762XOtherBLUE CROSS BLUE SHIELD
NC8907694Medicaid
NC8907694Medicaid