NPIMap

Organization Active NPI

Southeast Renal Associates PA

  • Specialist
  • Charlotte, NC
National Provider Identifier
1073697553
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHEAST RENAL ASSOCIATES PA
Practice address
2301 W Morehead St
Charlotte, NC 28208-5178
Phone
(704) 333-4217
Fax
(704) 927-1767
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Mrs. Jennifer Huneycutt
Title
Practice Administrator
Phone
(704) 927-1755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2301 W Morehead St
Charlotte, NC 28208-5178

Mailing address

2301 W Morehead St
Charlotte, NC 28208-5178
Phone (704) 333-4217

Other identifiers 3

IdentifierTypeStateIssuer
0109VOtherNCBCBS OF NC
NPA650MedicaidSC
890109VMedicaidNC

National Provider Directory

National Provider Directory

Locations

2301 W Morehead St
Charlotte, NC 28208
Phone (704) 333-4217

505 S Pearl St
#A
Pageland, SC 29728
Phone (704) 333-4217

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1073697553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 W MOREHEAD ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085178",
            "telephone_number": "704-333-4217",
            "fax_number": "704-927-1767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 W MOREHEAD ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085178",
            "telephone_number": "704-333-4217",
            "fax_number": "704-927-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST RENAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "HUNEYCUTT",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-927-1755",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "0109V",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPA650",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890109V",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.