SOUTHEAST RENAL ASSOCIATES PA (NPI# 1073697553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073697553 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST RENAL ASSOCIATES PA |
| Practice Address |
2301 W Morehead St Charlotte NC 28208-5178 |
| Practice Telephone | 7043334217 |
| Practice Fax Number | 7049271767 |
| Mailing Telephone | 7043334217 |
| Mailing Fax Number | 7049271767 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MRS. JENNIFER HUNEYCUTT (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 7049271755 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS OF NC | 0109V | 01 |
| SC | NPA650 | 05 | |
| NC | 890109V | 05 |
| Street Address |
2301 W MOREHEAD ST |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28208-5178 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710455985 | London Allen Perry | Social Worker | 2301 W Morehead St, Charlotte, NC 28208-5271 | 2018-11-06 |
| 1295272474 | Caroline Stroup | Community/Behavioral Health | 2301 W Morehead St, Charlotte, NC 28208-5271 | 2017-01-25 |
| 1265881072 | Sheree Danielle Harper | Counselor | 2301 W Morehead St, Suite B, Charlotte, NC 28208-5271 | 2016-06-13 |
| 1447658042 | Medlab Treatment Center | Internal Medicine | 2301 W Morehead St, Suite A, Charlotte, NC 28208-9798 | 2014-12-12 |
| 1467879395 | Yolonda Tindal | Social Worker | 2301 W Morehead St, Suite B, Charlotte, NC 28208-5271 | 2014-03-28 |
| 1629223565 | Procure Therapeutic Agency, Inc | Community/Behavioral Health | 2301 W Morehead St, Suite B, Charlotte, NC 28208-5271 | 2008-11-19 |
| 1497807515 | Amy Leigh Mock | Counselor | 2301 W Morehead St, Suite B, Charlotte, NC 28208-5271 | 2007-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124645544 | Charlotte Sp Senior Housing Opco, LLC | Custodial Care Facility | 6041 Piedmont Row Drive, Charlotte, NC 28208 | 2020-07-01 |
| 1750929659 | Tru Pearl Solution Services Pllc | Community/Behavioral Health | 2128 Remount Road Suite B, Charlotte, NC 28208 | 2019-12-11 |
| 1245880699 | Camilla A Raley | Technician | 1539 Walton Rd, Charlotte, NC 28208 | 2019-09-18 |
| 1912567041 | Nolan Scott Blake | In Home Supportive Care | 4926 Ridgeley Dr., Suite B, Charlotte, NC 28208 | 2019-06-20 |
| 1699244145 | Catalyst Chiropractic, Pllc | Chiropractor | 2620 Tuckaseegee Rd., Charlotte, NC 28208 | 2018-11-14 |
| 1255854691 | Jessica Lynne Hunter | Social Worker | 2011 Water Walk Lane Apt 209, Charlotte, NC 28208 | 2017-07-18 |
| 1700311420 | Matthew Christian Mundorf | Chiropractor | 2620 Tuckaseegee Rd, Charlotte, NC 28208 | 2017-05-01 |
| 1700235439 | Erin Merchant | Counselor | 2016 Millerton Avenue, #2213, Charlotte, NC 28208 | 2016-06-03 |
| 1528432564 | Monika Sheree Moore | Counselor | 3205 Freedom Dr, Charlotte, NC 28208 | 2015-11-13 |
| 1205224540 | Phadality Home Care | Home Health | 201 S Hoskins Rd., Suite 119, Charlotte, NC 28208 | 2015-01-08 |
| Find all providers in zip 28208 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598252207 | Kim Dudley | Specialist | 9208 Ardrey Kell Rd Ste 14, Charlotte, NC 28277-0786 | 2018-04-18 |
| 1568828994 | Darla Lilleberg | Specialist | 428 E 4th St, Suite 333, Charlotte, NC 28202-2434 | 2016-01-14 |
| 1508222175 | Candy Sue Benish | Specialist | 3349 Chilham Pl, Charlotte, NC 28226-3000 | 2016-01-12 |
| 1245614874 | Joseph Franklin Cline | Specialist | 8133 Ardrey Kell Rd Ste 203, Charlotte, NC 28277-5723 | 2015-07-14 |
| 1689055147 | James Salfia | Specialist | 9608 Rainbow Forest Dr, Charlotte, NC 28277-8773 | 2015-06-10 |
| 1811384720 | Diabetes and Metabolism Care Group Pllc | Specialist | 10344 Park Rd, Charlotte, NC 28210-8470 | 2015-04-17 |
| 1730579657 | Queen Charlotte Hair Replacement Center | Specialist | 5729 Cedars East Ct Apt 6, Charlotte, NC 28212-0192 | 2015-01-30 |
| 1285046573 | Said Yousef | Specialist | 8706 Holly Creek Ct, Charlotte, NC 28216-2666 | 2014-05-21 |
| 1235564758 | Barbara Jo Halton-bailey | Specialist | 231 Old Bell Rd, Charlotte, NC 28270-2792 | 2013-09-04 |
| 1508206061 | Amalia Cisneros | Specialist | 5800 N Sharon Amity Rd Ste B, Charlotte, NC 28215-5081 | 2013-06-28 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.