NPIMap

Organization Active NPI

Charlotte-Mecklenburg Health Services Foundation

  • Physical Medicine & Rehabilitation Physician
  • Charlotte, NC
National Provider Identifier
1699795989
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
CHARLOTTE-MECKLENBURG HEALTH SERVICES FOUNDATION
Practice address
1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone
(704) 355-2000
Fax
(704) 355-5073
NPI assigned
Jul 20, 2006
Last updated
Apr 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

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

Authorized official

Name
Mr. Dennie Underwood
Title
Administrator
Phone
(704) 355-3147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary

Addresses

Primary practice location

1100 Blythe Blvd
Charlotte, NC 28203-5814

Mailing address

PO Box 32861
Charlotte, NC 28232-2861
Phone (704) 512-6438

Other identifiers 1

IdentifierTypeStateIssuer
7901752MedicaidNC

Other names 1

  • Department of Rehabilitation Other name

National Provider Directory

National Provider Directory

Locations

1100 Blythe Blvd
Charlotte, NC 28203
Phone (704) 355-4300

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1699795989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32861",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282322861",
            "telephone_number": "704-512-6438",
            "fax_number": "704-512-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035814",
            "telephone_number": "704-355-2000",
            "fax_number": "704-355-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE-MECKLENBURG HEALTH SERVICES FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "DENNIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-355-3147",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901752",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Department of Rehabilitation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; 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.