Active NPI
Statesville Hma Medical Group LLC
- Surgery Physician
- Statesville, NC
National Provider Identifier
1184060717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- Legal business name
- STATESVILLE HMA MEDICAL GROUP LLC
- Practice address
- 218 Old Mocksville Rd
Statesville, NC 28625-1930 - Phone
- (704) 838-7165
- Fax
- (704) 878-2081
- NPI assigned
- May 22, 2013
- Organization subpart
- Yes
- Parent organization
- STATESVILLE HMA MEDICAL GROUP LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jennifer L Jackson
- Title
- Sr Dir Prov Enrollment & Onboarding
- Phone
- (615) 465-3334
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | Primary | ||
| Vascular Surgery Physician | 2086S0129X |
Addresses
Primary practice location
218 Old Mocksville Rd
Statesville, NC 28625-1930
Mailing address
4000 Meridian Blvd
Franklin, TN 37067-6325
Phone (615) 465-7203
Other names 1
- Statesville Vascular Institute
National Provider Directory
National Provider Directory- Part of
- Statesville Hma Medical Gro
Locations
218 Old Mocksville Rd
Statesville, NC 28625
Phone (704) 838-7461
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1642118400000",
"number": "1184060717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 MERIDIAN BLVD",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370676325",
"telephone_number": "615-465-7203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 OLD MOCKSVILLE RD",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286251930",
"telephone_number": "704-838-7165",
"fax_number": "704-878-2081"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STATESVILLE HMA MEDICAL GROUP LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "STATESVILLE HMA MEDICAL GROUP LLC",
"enumeration_date": "2013-05-22",
"last_updated": "2022-01-14",
"certification_date": "2022-01-14",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "JENNIFER",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
"authorized_official_telephone_number": "615-465-3334"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery, Vascular Surgery",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Statesville Vascular Institute",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Statesville Vascular Institute",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.