Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
CAROLINA PEDIATRIC SURGERY - HUNTERSVILLE
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST, INC.
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERVICES)
(704) 403-4146
Entity
Organization
Contact information
Practice address
9625 NORTHCROSS CENTER CT, SUITE 102-A, HUNTERSVILLE, NC 28078-7348
(704) 801-1240
(704) 801-1241
Mailing address
9625 NORTHCROSS CENTER CT, SUITE 102-A, HUNTERSVILLE, NC 28078-7348
(704) 801-1240
(704) 801-1241
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017CP
BCBS EFF PRIOR TO 7-1-07
NC
01
—
019FN
BCBS EFF 7-1-07
NC
01
—
355573
MAMSI
NC
05
—
5906850
—
NC
01
—
5914359
MEDICAID, GROUP, EFF 5/1/09
NC
05
—
QPB706
—
SC
Enumeration date
06/25/2007
Last updated
08/21/2012
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