Mooresville PPM LLC

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

MOORESVILLE PPM LLC

Practice address

170 Medical Park Rd
Suite 102
Mooresville, NC 28117-8540

Phone

(704) 660-4756

Fax

(704) 660-4751

NPI assigned

Nov 5, 2011

Organization subpart

Yes

Parent organization

MOORESVILLE PPM LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Jennifer L Jackson

Title

Sir Dir Prov Enrollment & Onboardin

Phone

(615) 465-3334

Specialties & licenses 2

Addresses

Other names 1

• Lake Norman Orthopedic Spine Center Doing business as

Part of

Mooresville PPM LLC

Member of 1

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

• Mooresville Hospital Management Associates LLC

  • General Acute Care Hospital
  • Mooresville, NC
  • NPI 1073568754

  Member Of

  NPD member

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

{
    "created_epoch": "1320451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642118400000",
    "number": "1497032304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325",
            "telephone_number": "615-465-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD",
            "address_2": "SUITE 102",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "704-660-4756",
            "fax_number": "704-660-4751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORESVILLE PPM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOORESVILLE PPM LLC",
        "enumeration_date": "2011-11-05",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SIR DIR PROV ENROLLMENT & ONBOARDIN",
        "authorized_official_telephone_number": "615-465-3334",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Norman Orthopedic Spine Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Norman Orthopedic Spine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC
• Mooresville PPM LLC

• Orthopaedic Surgery of the Spine Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Orthopaedic Surgery of the Spine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; 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.