Provider Demographics
NPI:1992787832
Name:TENET CENTRAL CAROLINA PHYSICIANS INC
Entity type:Organization
Organization Name:TENET CENTRAL CAROLINA PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2030
Mailing Address - Street 1:4546 HWY 87 S
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332
Mailing Address - Country:US
Mailing Address - Phone:919-499-5151
Mailing Address - Fax:919-499-5147
Practice Address - Street 1:4546 HWY 87 S
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332
Practice Address - Country:US
Practice Address - Phone:919-499-5151
Practice Address - Fax:919-499-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900142Medicaid
NC017NWOtherBCBS
DC7656OtherRAILROAD MEDICARE
DC7656OtherRAILROAD MEDICARE