Provider Demographics
NPI:1053389460
Name:CAROLINAS HEADACHE CLINIC
Entity type:Organization
Organization Name:CAROLINAS HEADACHE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-844-6615
Mailing Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2389
Mailing Address - Country:US
Mailing Address - Phone:704-844-6615
Mailing Address - Fax:704-844-6879
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY STE 310
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2389
Practice Address - Country:US
Practice Address - Phone:704-844-6615
Practice Address - Fax:704-844-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33740174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE04297Medicare UPIN
NC213539BMedicare ID - Type Unspecified