Basic Information
| Provider Information | |||||||||
| NPI: | 1710058086 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA INTERNAL MEDICINE ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 VANDERBILT PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282580397 | ||||||||
| FaxNumber: | 8282583390 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 VANDERBILT PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282580397 | ||||||||
| FaxNumber: | 8282583390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | KUBITSCHEK | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8282580397 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01155 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 8901155 | 05 | NC | MEDICAID |