Tenet Central Carolina Physicians Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

TENET CENTRAL CAROLINA PHYSICIANS INC

Doing business as

Mid Carolina Crossroads Surgical Clinic

Practice address

709 Wicker St
Ste B
Sanford, NC 27330-4142

Phone

(919) 774-1277

Fax

(919) 774-1101

NPI assigned

Nov 16, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael Kyle Burtnett

Title

SVP of Outpatient Services, Tenet

Phone

(469) 893-2153

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Mid Carolina Crossroads Surgical Clinic Doing business as

Locations

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464220800000",
    "number": "1083696926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741608",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303841608",
            "telephone_number": "919-774-1277",
            "fax_number": "919-774-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 WICKER ST",
            "address_2": "STE B",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273304142",
            "telephone_number": "919-774-1277",
            "fax_number": "919-774-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TENET CENTRAL CAROLINA PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2016-05-26",
        "status": "A",
        "authorized_official_last_name": "BURTNETT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "SVP OF OUTPATIENT SERVICES, TENET",
        "authorized_official_telephone_number": "469-893-2153",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903334",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF0988",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "017MY",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Carolina Crossroads Surgical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Surgery Physician in Sanford, NC
• Providers in Sanford, NC by specialty
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; 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.