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Organization

TENET CENTRAL CAROLINA PHYSICIANS INC

Active
Other names
Mid Carolina Crossroads Surgical Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL KYLE BURTNETT (SVP OF OUTPATIENT SERVICES, TENET)
(469) 893-2153
Entity
Organization

Contact information

Practice address
709 WICKER ST, STE B, SANFORD, NC 27330-4142
(919) 774-1277
(919) 774-1101
Mailing address
PO BOX 741608, ATLANTA, GA 30384-1608
(919) 774-1277
(919) 774-1101

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
208800000X
Urology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
017MY
BCBS
NC
05
5903334
NC
01
DF0988
RAILROAD MEDICARE
Enumeration date
11/16/2005
Last updated
05/26/2016
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