The Carolina Men's Clinic

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

0010-05337 Issued in NC

Legal business name

THE CAROLINA MEN'S CLINIC

Practice address

122 Gateway Blvd Ste D
Mooresville, NC 28117-5544

Phone

(704) 981-4490

NPI assigned

Nov 13, 2014

Last updated

Nov 13, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Beauchaine, PA

Title

Physician Assistant

Phone

(704) 981-4490

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415836800000",
    "number": "1548666878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 GATEWAY BLVD STE D",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 GATEWAY BLVD STE D",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175544",
            "telephone_number": "704-981-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CAROLINA MEN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-13",
        "last_updated": "2014-11-13",
        "status": "A",
        "authorized_official_last_name": "BEAUCHAINE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "704-981-4490",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NC",
            "license": "0010-05337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Medical Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2014; 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.