Basic Information
| Provider Information | |||||||||
| NPI: | 1912323189 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARTERET SURGICAL ASSOCIATES P.A. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CAROLINAS CENTER FOR INTERVENTIONAL PAIN MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 534 N 35TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285573182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527730617 | ||||||||
| FaxNumber: | 2527261805 | ||||||||
| Practice Location | |||||||||
| Address1: | 534 N 35TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285573182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527730614 | ||||||||
| FaxNumber: | 2527730617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2522225877 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARTERET SURGICAL ASSOCIATES P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
ID Information
| ID | Type | State | Issuer | Description | 5919028 | 05 | NC | MEDICAID |