Organization
CAROLINAS PHYSICIAN NETWORK, INC.
Active
Parent organization
CAROLINAS PHYSICIAN NETWORK INC
Other names
Sports Medicine and Injury Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS PHYSICIAN NETWORK INC
Authorized official
MR. THOMAS FORD LAYMON (SENIOR VICE PRESIDENT)
(704) 631-0002
Entity
Organization
Contact information
Practice address
101 E W T HARRIS BLVD, SUITE 5101, CHARLOTTE, NC 28262-3485
(704) 863-4878
(704) 863-1511
Mailing address
PO BOX 602148, CHARLOTTE, NC 28260-2148
(704) 863-4878
(704) 863-1511
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5922350
NC MEDICAID DME
NC
05
—
5922350
—
NC
05
—
NPB616
—
SC
Enumeration date
02/07/2013
Last updated
08/18/2016
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