Provider Demographics
NPI:1578502647
Name:CMC-NORTHEAST, INC.
Entity type:Organization
Organization Name:CMC-NORTHEAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-403-4146
Mailing Address - Street 1:920 CHURCH ST N
Mailing Address - Street 2:NORTHEAST CRITICAL CARE ASSOC
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2927
Mailing Address - Country:US
Mailing Address - Phone:704-403-1311
Mailing Address - Fax:704-403-2533
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:NORTHEAST CRITICAL CARE ASSOC
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1311
Practice Address - Fax:704-403-2533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMC-NORTHEAST, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0272NOtherBCBS EFF PRIOR TO 7-1-07
NC7391OtherPARTNERS MEDICARE CHOICE
NC176392OtherWELLPATH GROUP ID
NC2114735OtherMAMSI
NC566000156034OtherTRICARE STANDARD, NON NWK
NC890272NMedicaid
NCCC2854OtherRAILROAD MEDICARE
NC019GROtherBCBS EFF 7-1-07
NCDF8926OtherRAILROAD MEDICARE PTAN
NC5906852Medicaid
NC5906852Medicaid
NC5906852Medicaid
NC2325363Medicare PIN