Novant Health Medical Group, LLC
Organization Active NPI Hospice and Palliative Medicine (Internal Medicine) Physician · Charlotte, NC
NPI 1174202170 · NPPES record last updated Jun 13, 2024
Key facts
- NPI
- 1174202170
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 10905 Providence Road W
Charlotte, NC 28277-1538 - Phone
- (704) 384-6478
- Fax
- (704) 316-9643
- NPI assigned
- Jul 17, 2023
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Corporate family (same tax ID) 24
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled 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 |
National Provider Directory
- Tax ID family
- Presbyterian Inpt Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Internal Medicine) Physician |
207RH0002X | Yes |
Addresses
Primary practice location
10905 Providence Road W
Charlotte, NC 28277-1538
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-6478
Other names
- Novant Health Palliative Care
Other providers in Charlotte, NC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
All providers in Charlotte, NC · Hospice and Palliative Medicine (Internal Medicine) 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 13, 2024. 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.