Basic Information
| Provider Information | |||||||||
| NPI: | 1447420864 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-CAROLINA HOMECARE SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 AIRPORT BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194659300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 AIRPORT BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194659300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2008 | ||||||||
| LastUpdateDate: | 06/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | DUNSTON | ||||||||
| AuthorizedOfficialFirstName: | DESIREE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REIMBURSEMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9194602582 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | HC1801 | NC | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 7703063 | 05 | NC | MEDICAID | 0448V | 01 | NC | BC/BS OF NC | OTHER |