NPIMap

Organization Active NPI

Cardinal Clinic LLC

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1982761250
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CARDINAL CLINIC LLC
Practice address
1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510
Phone
(910) 867-8889
NPI assigned
Jan 3, 2007
Last updated
May 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Authorized official

Name
Tony Garcia
Title
QM Coordinator
Phone
(910) 864-0187

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X
Psychologist 103T00000X
Clinical Child & Adolescent Psychologist 103TC2200X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510

Mailing address

1540 Purdue Dr Ste 200
Fayetteville, NC 28303-5510
Phone (910) 867-8889

Other identifiers 1

IdentifierTypeStateIssuer
8300391MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Cardinal Clinic LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1982761250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 PURDUE DR STE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035510",
            "telephone_number": "910-867-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 PURDUE DR STE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035510",
            "telephone_number": "910-867-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDINAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "QM COORDINATOR",
        "authorized_official_telephone_number": "910-864-0187"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300391",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; 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.