NPIMap

Novant Health Medical Group, LLC

Organization Active NPI Pediatrics Physician · Charlotte, NC

NPI 1184679359 · NPPES record last updated Jun 20, 2024

Key facts

NPI
1184679359
Entity type
Organization (NPI type 2)
Primary specialty
Pediatrics Physician 208000000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Practice address
14215 Ballantyne Corporate PL
Suite 130
Charlotte, NC 28277-3671
Phone
(704) 384-1950
Fax
(704) 384-1955
NPI assigned
May 24, 2006
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1046455Novant Health Ballantyne Pediatrics
14215 Ballantyne Corporate Place, Suite 130, Charlotte, NC 28277		ComplianceMay 19, 2028

National Provider Directory

Tax ID family
Presbyterian Inpt Care (503 organizations share this tax ID)

Locations

14215 Ballantyne Corporate Pl
Ste 1
Charlotte, NC 28277

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X NC Yes

Addresses

Primary practice location

14215 Ballantyne Corporate PL
Suite 130
Charlotte, NC 28277-3671

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7283

Other identifiers

IdentifierTypeStateIssuer
89014UFMedicaidNC
014UFOtherNCBCBS NC
NPB265MedicaidSC

Other names

  • Novant Health Ballantyne Pediatrics Doing business as

Other providers in Charlotte, NC

All providers in Charlotte, NC · Pediatrics Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.