Carolina Medicorp Enterprises, Inc
Organization Active NPI Family Medicine Physician · Davidson, NC
NPI 1104239953 · NPPES record last updated Aug 19, 2014
Key facts
- NPI
- 1104239953
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CAROLINA MEDICORP ENTERPRISES, INC
- Practice address
- 610 Jetton St
Suite 214
Davidson, NC 28036-9320 - Phone
- (704) 384-1555
- Fax
- (704) 384-1557
- NPI assigned
- Jun 10, 2014
- Organization subpart
- No
Authorized official
- Name
- Geoffrey K Gardner
- Title
- VP of Finance
- Phone
- (704) 384-7203
Other NPIs on the same Medicare enrollment 32
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040110000190 | NC | Part B Supplier - Clinic/Group Practice | 0648174904 |
Receives reassigned benefits from 249 practitioners 32 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cornelius, NC; Greensboro, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Kernersville, NC; Lexington, NC; Matthews, NC… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
610 Jetton St
Suite 214
Davidson, NC 28036-9320
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Other names
- Novant Health Express
Other providers in Davidson, NC
- Cindy Lou Butkiewicz
- Breonna Caldwell
- Aimee Campagna
- Angela Carbonaro
- Marla Yamileth Carcamo
- Carolinas Medical Center
- Carolinas Medical Center-Northeast
- Carolinas Medical Center-Northeast
- Carolinas Physicians Network Inc
- Carolinas Physicians Network Inc
All providers in Davidson, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.