Carolina Vascular Specialists, PA

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

CAROLINA VASCULAR SPECIALISTS, PA

Practice address

146 Medical Park Rd
Suite 102
Mooresville, NC 28117-8528

Phone

(704) 799-3939

Fax

(704) 799-8748

NPI assigned

Apr 12, 2011

Last updated

Oct 13, 2011By 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

Wallace C Tarry, M.D.NPI 1205804945

Title

Owner/Provider

Phone

(704) 799-3939

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wallace Clements Tarry, MD

  • Vascular Surgery Physician
  • Mooresville, NC
  • NPI 1205804945
  Authorized official Same address or phone

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1750671723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK RD",
            "address_2": "SUITE 102",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178528",
            "telephone_number": "704-799-3939",
            "fax_number": "704-799-8748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 MEDICAL PARK RD",
            "address_2": "SUITE 102",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178528",
            "telephone_number": "704-799-3939",
            "fax_number": "704-799-8748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA VASCULAR SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-12",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "TARRY",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "704-799-3939",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917234",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolina Family Medicine & Wellness
• Carolina Foot & Ankle of Huntersville, PC
• Carolina Hearing and Tinnitus, PC
• Carolina Pain and Weight Loss
• Carolina Spine & Pain Center, PLLC
• Carolina Vein Associates, PLLC
• Carolinas Fertility Institute, P.a.
• Carolinas Physicians Network Inc (Atrium Health Women's Care One Health OB GYN)
• Carolinas Physicians Network Inc (Mooresville Family Medicine)
• Carolinas Physicians Network Inc (The Sanger Clinic)

• Vascular Surgery Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Vascular Surgery Physician in North Carolina

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