Presbyterian Regional Healthcare Corp.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRESBYTERIAN REGIONAL HEALTHCARE CORP.

Doing business as

Mallard Creek Family Physicians

Practice address

10320 Mallard Creek Rd
Suite 100
Charlotte, NC 28262-9756

Phone

(704) 547-9500

Fax

(704) 547-9515

NPI assigned

May 27, 2006

Organization subpart

No

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

Authorized official

Name

Patrick D. Easterling

Title

Sr. VP of Finance

Phone

(704) 384-9094

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mallard Creek Family Physicians Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972550994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 RANDOLPH RD",
            "address_2": "SUITE 500",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071106",
            "telephone_number": "704-384-9679",
            "fax_number": "704-316-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10320 MALLARD CREEK RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282629756",
            "telephone_number": "704-547-9500",
            "fax_number": "704-547-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN REGIONAL HEALTHCARE CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EASTERLING",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "SR. VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-9094"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900657",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mallard Creek Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Presbyterian Regional Healthcare Corp
• Presbyterian Regional Healthcare Corp
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• Family Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.