Organization
CMC-NORTHEAST, INC.
Active
Other names
CRNA
Organization subpart
No
Provider details
NPI number
Authorized official
MARK NANTZ (CHIEF ADMINISTRATIVE OFFICER)
(704) 783-1176
Entity
Organization
Contact information
Practice address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 403-3000
Mailing address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 403-3000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232009A
MEDICARE GROUP PTAN
NC
05
—
8000181
—
NC
Enumeration date
10/10/2006
Last updated
09/18/2007
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