Basic Information
| Provider Information | |||||||||
| NPI: | 1881021202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY | ||||||||
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| OtherOrganizationName: | NORTHEAST RHEUMATOLOGY-UNIVERSITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E W T HARRIS BLVD | ||||||||
| Address2: | BLDG 3000, SUITE 3301-G | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282627000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044031308 | ||||||||
| FaxNumber: | 7044031194 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E W T HARRIS BLVD | ||||||||
| Address2: | BLDG 3000, SUITE 3301-G | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282627000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044031308 | ||||||||
| FaxNumber: | 7044031194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2013 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | LAYMON | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7044032276 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.