Basic Information
| Provider Information | |||||||||
| NPI: | 1386607505 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL CAROLINA WOMEN'S CENTER, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 N FAYETTEVILLE ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272035572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366266371 | ||||||||
| FaxNumber: | 3366290436 | ||||||||
| Practice Location | |||||||||
| Address1: | 237 N FAYETTEVILLE ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ASHEBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272035572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366266371 | ||||||||
| FaxNumber: | 3366290436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PRYCE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3366266371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MBA, MHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 890114B | 05 | NC | MEDICAID | 0159Y | 01 | NC | BCBS GROUP NUMBER | OTHER |