Organization
MEMA SC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WAYNE ICENHOUR CMPE (CHIEF OPERATING OFFICER)
(704) 319-5822
Entity
Organization
Contact information
Practice address
501 S SHARON AMITY RD, STE 300, CHARLOTTE, NC 28211-0035
(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
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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