Carolina Medicorp Enterprises, Inc
Organization Active NPI Family Medicine Physician · Clemmons, NC
NPI 1649512922 · NPPES record last updated Mar 31, 2016
Key facts
- NPI
- 1649512922
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CAROLINA MEDICORP ENTERPRISES, INC
- Practice address
- 4136 Clemmons Rd
Clemmons, NC 27012-7520 - Phone
- (336) 893-3270
- NPI assigned
- Mar 25, 2013
- Organization subpart
- No
Authorized official
- Name
- Geoffrey K Gardner
- Title
- VP of NMG Finance
- Phone
- (704) 384-9144
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
4136 Clemmons Rd
Clemmons, NC 27012-7520
Mailing address
PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 893-3270
Other names
- Novant Health Express Care
Other providers in Clemmons, NC
- Thane Robert Campbell
- Manuel Alejandro Cano
- Carenet, Inc.
- Carillon Assisted Living of Clemmons, LLC
- Carolina Hearing Doctors, Inc.
- Lisa D Carpenter
- Danielle Marguerite Carter Adkins
- Melissa H Casstevens
- Susannah Sharpe Cecil
- Certified Health Services, LLC
All providers in Clemmons, 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 Mar 31, 2016. 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.