Basic Information
| Provider Information | |||||||||
| NPI: | 1568873198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARIATRIC SPECIALISTS OF NORTH CAROLINA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MACGREGOR SLEEP CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 WILLIAM PENN PLZ | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192205255 | ||||||||
| FaxNumber: | 9193131276 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 MACGREGOR PINES DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192344468 | ||||||||
| FaxNumber: | 8778274738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2014 | ||||||||
| LastUpdateDate: | 06/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | DIMMIG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | ALVA | ||||||||
| AuthorizedOfficialTitleorPosition: | MD, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9192205255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 39442 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02837 | 01 | NC | BCBSNC | OTHER |