Basic Information
| Provider Information | |||||||||
| NPI: | 1407808389 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA DIAGNOSTICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | |||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359757 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 KANDEMOR LN | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278043212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529376692 | ||||||||
| FaxNumber: | 2529376697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | IBERGER | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EVP-CFO | ||||||||
| AuthorizedOfficialTelephone: | 9785366105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 12467 | 01 | NC | BCBS PIN | OTHER | P00391188 | 01 | NC | RR MEDICARE | OTHER | 89013EP | 05 | NC | MEDICAID |