| Carolina Express Clinic | |
|
5110 Park Rd 1j Charlotte NC 28209 | |
| (704) 496-9100 | |
| Not Available |
| Full Name | Carolina Express Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 5110 Park Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Gregory S Chambers (OWNER/PROVIDER) |
| Authorized Official Contact | 7045720154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolina Express Clinic 5110 Park Rd 1j Charlotte NC 28209 Ph: (704) 572-0154 | Carolina Express Clinic 5110 Park Rd 1j Charlotte NC 28209 Ph: (704) 496-9100 |
| NPI Number | 1427483601 |
|---|---|
| Provider Enumeration Date | 09/06/2013 |
| Last Update Date | 06/13/2014 |
| Medicare PECOS PAC ID | 5799910642 |
|---|---|
| Medicare Enrollment ID | O20131030000863 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427483601 | NPI | - | NPPES |
| 1659346492 | Other | NC | NPI TYPE I: 1659346492 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 001000254 (North Carolina) | Primary |
| Provider Name | Amanda Chamelle Ivey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770970873 PECOS PAC ID: 9234434143 Enrollment ID: I20160607001916 |
| Provider Name | Ashli Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861923302 PECOS PAC ID: 6901173053 Enrollment ID: I20170522001838 |
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