Novant Medical Group, Inc.
Organization Active NPI Orthopaedic Surgery Physician · Southport, NC
NPI 1043495005 · NPPES record last updated Jun 27, 2011
Key facts
- NPI
- 1043495005
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- NOVANT MEDICAL GROUP, INC.
- Practice address
- 902 North Howe Street
Southport, NC 28461-3038 - Phone
- (910) 457-4789
- NPI assigned
- Jan 8, 2008
- Organization subpart
- No
Authorized official
- Name
- Michelle Grier
- Title
- Senior VP Coo of NMG
- Phone
- (704) 384-7607
Other NPIs on the same Medicare enrollment 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031121000692 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 3,607 practitioners This NPI is an additional NPI on the enrollment |
| O20080207000174 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 33 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wake Forest, NC; Salisbury, NC; Bolivia, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes |
Addresses
Primary practice location
902 North Howe Street
Southport, NC 28461-3038
Mailing address
PO Box 602362
Charlotte, NC 28260-2362
Phone (704) 384-7840
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5908887 | Medicaid | NC |
Other names
- Orthopaedic Specialists
Other providers in Southport, NC
- North Carolina CVS Pharmacy LLC
- North Carolina Shoulder and Elbow Surgery and Sports Medicine
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Medical Group Inc
- Novant Medical Group, Inc.
- Novant Medical Group, Inc.
- Novant Medical Group, Inc.
- Novant Medical Group, Inc.
- Edgar E Null
All providers in Southport, NC · Orthopaedic Surgery Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.