NPIMap

Organization Active NPI

Carolina Outreach, LLC

  • Clinical Medical Laboratory
  • Fayetteville, NC
National Provider Identifier
1063802718
Registry record updated Feb 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
34D2070270 Issued in NC
Legal business name
CAROLINA OUTREACH, LLC
Practice address
911 Hay St
Fayetteville, NC 28305-5313
Phone
(910) 438-0939
NPI assigned
Feb 3, 2015
Last updated
Feb 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rob Davis
Title
Human Resources
Phone
(919) 251-9001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 34D2070270 NC Primary

Addresses

Primary practice location

911 Hay St
Fayetteville, NC 28305-5313

Mailing address

911 Hay St
Fayetteville, NC 28305-5313
Phone (910) 438-0939

Other identifiers 1

IdentifierTypeStateIssuer
34D2085455OtherNCCLIA CERTIFICATION

National Provider Directory

National Provider Directory
Tax ID family
Carolina Outreach LLC19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422921600000",
    "number": "1063802718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 HAY ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055313",
            "telephone_number": "910-438-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 HAY ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055313",
            "telephone_number": "910-438-0939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA OUTREACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-03",
        "last_updated": "2015-02-03",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "HUMAN RESOURCES",
        "authorized_official_telephone_number": "919-251-9001"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "34D2070270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA CERTIFICATION",
            "identifier": "34D2085455",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.