Organization
CMC-NORTHEAST, INC.
Active
Organization
CMC-NORTHEAST, INC.
Active
Parent organization
CMC-NORTHEAST, INC.
Other names
NORTHEAST PEDIATRIC INTENSIVISTS
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
920 CHURCH ST N, NORTHEAST PEDIATRIC INTENSIVISTS, CONCORD, NC 28025-2927
(704) 403-3040
(704) 403-3043
Mailing address
920 CHURCH ST N, NORTHEAST PEDIATRIC INTENSIVISTS, CONCORD, NC 28025-2927
(704) 403-3040
(704) 403-3043
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014XC
BCBS GROUP ID
NC
01
—
019FR
BCBS EFF 7-1-07
NC
01
—
125262
WELLPATH GROUP ID
NC
01
—
355573
MAMSI
NC
01
—
566000156002
TRICARE STANDARD, NON NWK
NC
05
—
5906951
—
NC
05
—
89014XC
—
NC
01
—
CC2854
RAILROAD MEDICARE
NC
01
—
DF8926
RAILROAD MEDICARE PTAN
NC
Enumeration date
06/05/2006
Last updated
06/01/2010
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