Basic Information
| Provider Information | |||||||||
| NPI: | 1427374578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA MOUNTAIN EMERGENCY MEDICINE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602389 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432373378 | ||||||||
| FaxNumber: | 8432379736 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 RANKIN DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287526568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286595000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2010 | ||||||||
| LastUpdateDate: | 04/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | HUNT | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8286595000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | CD1694 | 01 | RAILROAD MEDICARE | OTHER |