Basic Information
| Provider Information | |||||||||
| NPI: | 1144248055 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY INTERNAL MEDICINE AT CHAPEL HILL NORTH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 W FRANKLIN ST | ||||||||
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| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275162539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198434810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1838 MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | SUITE 19B | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275147415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198434810 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | DAUGIRD | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 9199607461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 790258L | 05 | NC | MEDICAID |