Provider Demographics
NPI:1548291917
Name:MARY CARVER-BAYSDON
Entity type:Organization
Organization Name:MARY CARVER-BAYSDON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARVER-BAYSDON
Authorized Official - Suffix:
Authorized Official - Credentials:CFO/DME
Authorized Official - Phone:910-272-9900
Mailing Address - Street 1:PO BOX 3576
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359
Mailing Address - Country:US
Mailing Address - Phone:910-272-9900
Mailing Address - Fax:
Practice Address - Street 1:2201 -C NORTH PINE STREET
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-272-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC312892335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1984Medicaid
NC7703385Medicaid
NC4234140001Medicare NSC