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Organization
MID-ATLANTIC EMERGENCY MEDICAL ASSOCIATES, PLLC
Active
Organization
MID-ATLANTIC EMERGENCY MEDICAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE ICENHOUR (CHIEF OPERATING OFFICER)
(704) 319-5822
Entity
Organization
Contact information
Practice address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211
(704) 377-2424
(704) 377-2687
Mailing address
501 S SHARON AMITY RD STE 300, CHARLOTTE, NC 28211-0035
(704) 377-2424
(704) 377-2687
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0294W
BCBSNC
NC
05
—
89-01401
—
NC
05
—
89-016RM
—
NC
05
—
89-0294W
—
NC
05
—
89-0295G
—
NC
05
—
89-0295H
—
NC
01
—
CI1307
RR MEDICARE
NC
05
—
NPA807
—
SC
05
—
NPA822
—
SC
05
—
QPA372
—
SC
05
—
QPA373
—
SC
Enumeration date
05/09/2006
Last updated
07/03/2018
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