Basic Information
| Provider Information | |||||||||
| NPI: | 1801985395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINAS WOMEN'S CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 MCALPINE LN | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283524637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102773331 | ||||||||
| FaxNumber: | 9102773336 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 MCALPINE LN | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283524637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102773331 | ||||||||
| FaxNumber: | 9102773336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL-FRYE | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9102773331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0172Q | 01 | NC | NC BCBS GROUP NUMBER | OTHER | 2334943 | 01 | NC | NC MEDICARE GROUP NUMBER | OTHER | 590172Q | 01 | NC | NC MEDICAID GROUP NUMBER | OTHER | CG9085 | 01 | NC | RR MEDICARE GROUP NUMBER | OTHER | NPA864 | 01 | SC | SC MEDICAID GROUP NUMBER | OTHER |