NPIMap

Organization Active NPI

Cleveland Health Ventures LLC

Doing business as Kings Mountain Infectious Disease

  • Infectious Disease Physician
  • Kings Mountain, NC
National Provider Identifier
1396070652
Registry record updated Jun 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
CLEVELAND HEALTH VENTURES LLC
Doing business as
Kings Mountain Infectious Disease
Practice address
502 W King St
Suite B
Kings Mountain, NC 28086-3362
Phone
(980) 487-2299
Fax
(704) 730-8262
NPI assigned
Oct 5, 2009
Last updated
Jun 28, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
CLEVELAND HEALTH VENTURES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Daniel Wiens
Title
Senior Vice President
Phone
(704) 355-0648

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

502 W King St
Suite B
Kings Mountain, NC 28086-3362

Mailing address

PO Box 602341
Charlotte, NC 28260-2341

Other identifiers 2

IdentifierTypeStateIssuer
NPB363MedicaidSC
5914028MedicaidNC

Other names 1

  • Kings Mountain Infectious Disease Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cleveland Health Ventures10 organizations share this tax ID, including this one
Part of
Cleveland Health Ventures

Other organizations with this tax ID 9

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

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Locations

502 W King St
Ste B
Kings Mtn, NC 28086
Phone (980) 487-2299

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277683200000",
    "number": "1396070652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602341",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W KING ST",
            "address_2": "SUITE B",
            "city": "KINGS MOUNTAIN",
            "state": "NC",
            "postal_code": "280863362",
            "telephone_number": "980-487-2299",
            "fax_number": "704-730-8262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND HEALTH VENTURES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEVELAND HEALTH VENTURES LLC",
        "enumeration_date": "2009-10-05",
        "last_updated": "2010-06-28",
        "status": "A",
        "authorized_official_last_name": "WIENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-355-0648",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB363",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5914028",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kings Mountain Infectious Disease",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kings Mountain, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.