NPIMap

Novant Health Medical Group, LLC

Organization Active NPI Psychiatry Physician · Winston Salem, NC

NPI 1235666231 · NPPES record last updated Jun 20, 2024

Key facts

NPI
1235666231
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Practice address
140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6160
Phone
(704) 316-7585
Fax
(704) 338-6422
NPI assigned
May 22, 2017
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.

Practitioners 6

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
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 (503 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

140 Kimel Park Dr Ste 200
Winston Salem, NC 27103-6160

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-7585

Other names

  • Novant Health Adult Psychiatric Medicine Doing business as
  • Novant Health Psychiatric Medicine Doing business as

Other providers in Winston Salem, NC

All providers in Winston Salem, NC · Psychiatry Physician in North Carolina

Sources for this page

Verify at the official NPI Registry.