Basic Information
| Provider Information | |||||||||
| NPI: | 1427087253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA DIAGNOSTICS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE PL | ||||||||
| Address2: | SUITE 5B | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019603840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785367400 | ||||||||
| FaxNumber: | 9785359757 | ||||||||
| Practice Location | |||||||||
| Address1: | 3921 SUNSET RIDGE RD | ||||||||
| Address2: | SUITE 103A | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198811167 | ||||||||
| FaxNumber: | 9198812055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | NAUFUL | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP COMPLIANCE & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 7703092000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | 12467 | 01 | NC | BCBS PIN | OTHER | 5950491 | 05 | NC | MEDICAID | P00391188 | 01 | NC | RAILROAD MEDICARE | OTHER |