NPIMap

Novant Health Thomasville Medical Center, LLC

Organization Active NPI Hematology & Oncology Physician · Kernersville, NC

NPI 1043965429 · NPPES record last updated Jul 10, 2023

Key facts

NPI
1043965429
Entity type
Organization (NPI type 2)
Primary specialty
Hematology & Oncology Physician 207RH0003X
Legal business name
NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC
Practice address
1710 Kernersville Medical Pkwy Ste 116
Kernersville, NC 27284-7156
Phone
(336) 564-4170
Fax
(336) 564-4936
NPI assigned
Feb 15, 2022
Organization subpart
No

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031222000916 NC Part B Supplier - Clinic/Group Practice 5890605224 Receives reassigned benefits from 747 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greensboro, NC; Winston-Salem, NC; Winston Salem, NC; Thomasville, NC; Kernersville, NC; Clemmons, NC

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RH0003X Yes

Addresses

Primary practice location

1710 Kernersville Medical Pkwy Ste 116
Kernersville, NC 27284-7156

Mailing address

PO Box 60516
Charlotte, NC 28260-0516

Other names

  • Novant Health Cancer Institute Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 10, 2023.

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1043965429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60516",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 KERNERSVILLE MEDICAL PKWY STE 116",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847156",
            "telephone_number": "336-564-4170",
            "fax_number": "336-564-4936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-15",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Cancer Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Cancer Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kernersville, NC

All providers in Kernersville, NC · Hematology & Oncology Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.