NPIMap

Organization Active NPI

Iredell Physician Network LLC

Doing business as Iredell Ear, Nose and Throat

  • Otolaryngology Physician
  • Statesville, NC
National Provider Identifier
1447063920
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
Iredell Ear, Nose and Throat
Practice address
740 Bryant St
Statesville, NC 28677-4143
Phone
(704) 878-6272
Fax
(704) 878-6273
NPI assigned
Jan 29, 2025
Last updated
Jan 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Authorized official

Name
Carla D Johnson
Title
Director of Operations
Phone
(980) 434-3803

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

740 Bryant St
Statesville, NC 28677-4143

Mailing address

766 Hartness Rd Ste B
Statesville, NC 28677-3485

Other names 1

  • Iredell Ear, Nose and Throat Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000651 NC Part B Supplier - Clinic/Group Practice 0749345007 Receives reassigned benefits from 139 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Statesville, NC; Taylorsville, NC; Troutman, NC; Hickory, NC; Harmony, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory
Tax ID family
Lakeview OBGYN23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

3210 Harmony Hwy
Harmony, NC 28634
Phone (704) 546-7587

101 Wilkesboro St
#B
Mocksville, NC 27028
Phone (336) 753-0800

101 Wilkesboro St
Ste B
Mocksville, NC 27028
Phone (336) 753-0800

444 Williamson Rd
Ste B
Mooresville, NC 28117
Phone (704) 360-3910

653 Bluefield Rd
Ste D
Mooresville, NC 28117
Phone (704) 360-6470

1540 E Broad St
Ste A
Statesville, NC 28625
Phone (704) 878-4958

211 S Tradd St
Statesville, NC 28677
Phone (704) 380-3620

218 Old Mocksville Rd
Ste 1G
Statesville, NC 28625
Phone (704) 873-0281

701 Bryant St
Statesville, NC 28677
Phone (704) 380-2711

738 Bryant St
Ste A
Statesville, NC 28677
Phone (704) 873-1180

766 Hartness Rd
Ste B
Statesville, NC 28677

766 Hartness Rd
Ste C
Statesville, NC 28677
Phone (704) 954-8277

Practitioners & affiliated clinicians

Practitioners 138

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.

View all 138

NPI Registry JSON

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

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1447063920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766 HARTNESS RD STE B",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 BRYANT ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774143",
            "telephone_number": "704-878-6272",
            "fax_number": "704-878-6273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-29",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "980-434-3803"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Ear, Nose and Throat",
            "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 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.