Basic Information
| Provider Information | |||||||||
| NPI: | 1659379972 | ||||||||
| 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 | ||||||||
| FaxNumber: | 9194659310 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 AIRPORT BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194659300 | ||||||||
| FaxNumber: | 9194659310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCULLOUGH | ||||||||
| AuthorizedOfficialFirstName: | DESIREE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REIMBURSEMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9194659300 | ||||||||
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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 | 251F00000X | HC1801 | NC | X | Agencies | Home Infusion | 333600000X | 07363 | NC | X | Suppliers | Pharmacy | 332BP3500X | HC1801 | NC | X | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332B00000X | HC1801 | NC | X | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | 07363 | NC | X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 6800414 | 05 | NC | MEDICAID | 7703063 | 05 | NC | MEDICAID | 04380 | 01 | NC | BC/BS OF NC HOME INFUSION | OTHER | 0920077 | 05 | NC | MEDICAID | 0448V | 01 | NC | BC/BS OF NC DME | OTHER |