Active NPI
Carolina Healthcare Associates, Inc.
- Internal Medicine Physician
- Burgaw, NC
National Provider Identifier
1265733406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- CAROLINA HEALTHCARE ASSOCIATES, INC.
- Practice address
- 209B US Highway 117 N
Burgaw, NC 28425-5101 - Phone
- (910) 259-0600
- Fax
- (910) 259-3444
- NPI assigned
- Nov 4, 2010
- Organization subpart
- Yes
- Parent organization
- CAROLINA HEALTHCARE ASSOCIATES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Dan E Goodwin
- Title
- VP
- Phone
- (910) 667-7597
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
209B US Highway 117 N
Burgaw, NC 28425-5101
Mailing address
PO Box 602484
Charlotte, NC 28260-2484
Phone (910) 259-0600
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5917056 | Medicaid | NC | |
| QPB708 | Medicaid | SC | |
| 1265733406 | Medicaid | NC |
Other names 1
- Pender Primary Care - Burgaw
National Provider Directory
National Provider Directory- Part of
- Carolina Healthcare Assoc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288828800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1484006400000",
"number": "1265733406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602484",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602484",
"telephone_number": "910-259-0600",
"fax_number": "910-259-3444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209B US HIGHWAY 117 N",
"city": "BURGAW",
"state": "NC",
"postal_code": "284255101",
"telephone_number": "910-259-0600",
"fax_number": "910-259-3444"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CAROLINA HEALTHCARE ASSOCIATES, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CAROLINA HEALTHCARE ASSOCIATES INC",
"enumeration_date": "2010-11-04",
"last_updated": "2017-01-10",
"status": "A",
"authorized_official_last_name": "GOODWIN",
"authorized_official_first_name": "DAN",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "VP",
"authorized_official_telephone_number": "910-667-7597",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5917056",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "QPB708",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1265733406",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pender Primary Care - Burgaw",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Burgaw, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.