Novant Medical Group, Inc.
Organization Active NPI Obstetrics & Gynecology Physician · Mint Hill, NC
NPI 1265993174 · NPPES record last updated Mar 26, 2019
Key facts
- NPI
- 1265993174
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- NOVANT MEDICAL GROUP, INC.
- Practice address
- 11300 Cresthill Dr Ste 100
Mint Hill, NC 28227-7924 - Phone
- (704) 316-2319
- Fax
- (704) 316-2321
- NPI assigned
- Mar 26, 2019
- Organization subpart
- No
Authorized official
- Name
- Shala Davis
- Title
- Manager
- Phone
- (704) 316-7845
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | Yes |
Addresses
Primary practice location
11300 Cresthill Dr Ste 100
Mint Hill, NC 28227-7924
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other names
- Novant Health Mint Hill OB/GYN
NPI Registry JSON
{
"created_epoch": "1553558400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1553558400000",
"number": "1265993174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60447",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282600447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11300 CRESTHILL DR STE 100",
"city": "MINT HILL",
"state": "NC",
"postal_code": "282277924",
"telephone_number": "704-316-2319",
"fax_number": "704-316-2321"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2019-03-26",
"last_updated": "2019-03-26",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "SHALA",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "704-316-7845"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Novant Health Mint Hill OB/GYN",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mint Hill, NC
- New Place, Inc.
- Nia Properties
- North Carolina CVS Pharmacy LLC
- North Carolina Health Operations LLC
- Novant Health Medical Group, LLC
- Novant Medical Group, Inc.
- Novant Medical Group, Inc.
- Diana Opiyo
- Origin Rehabilitation, LLC
- Mark E Oxendine
All providers in Mint Hill, NC · Obstetrics & Gynecology 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 Mar 26, 2019. 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.