Provider Demographics
NPI:1053367086
Name:CAROLINA KIDNEY ASSOCIATES
Entity type:Organization
Organization Name:CAROLINA KIDNEY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONNEL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-379-9708
Mailing Address - Street 1:309 NEW STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3654
Mailing Address - Country:US
Mailing Address - Phone:336-379-9708
Mailing Address - Fax:336-379-8714
Practice Address - Street 1:212 FOUST STREET
Practice Address - Street 2:CAROLINA KIDNEY ASSOCIATES PA
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5404
Practice Address - Country:US
Practice Address - Phone:336-626-0443
Practice Address - Fax:336-379-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01598OtherCKA'S BCBS GP PROV #
NCCD6638OtherCKA'S RRM GP PROV #
NC8901598Medicaid
NC=========OtherCKA'S TAX ID #