Provider Demographics
NPI:1609944024
Name:CAROLINA MEDICAL SPECIALTIES, INC.
Entity type:Organization
Organization Name:CAROLINA MEDICAL SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SLEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-485-0500
Mailing Address - Street 1:PO BOX 53277
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-3277
Mailing Address - Country:US
Mailing Address - Phone:910-485-0500
Mailing Address - Fax:910-485-2600
Practice Address - Street 1:1111 1/2 BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4513
Practice Address - Country:US
Practice Address - Phone:910-485-0500
Practice Address - Fax:910-485-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01069332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704467Medicaid
NC7704467Medicaid