Basic Information
| Provider Information | |||||||||
| NPI: | 1477193589 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UWH OF NORTH CAROLINA, PLLC | ||||||||
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| OtherOrganizationName: | UWH OF NORTH CAROLINA, LLP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PERIMETER PARK DR STE C | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275609714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193340123 | ||||||||
| FaxNumber: | 9193340152 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PERIMETER PARK DR STE C | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275609714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193340123 | ||||||||
| FaxNumber: | 9193340152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2020 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | WALKER | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5613002410 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UWH OF NORTH CAROLINA LLP | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0007X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology |
No ID Information.