NPIMap

Organization Active NPI

Novant Medical Group Inc

Doing business as Novant Health Lakeside Family Physicians

  • Emergency Medicine Physician
  • Cornelius, NC
National Provider Identifier
1730439944
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
NOVANT MEDICAL GROUP INC
Doing business as
Novant Health Lakeside Family Physicians
Practice address
19485 Old Jetton Rd
Suite 100
Cornelius, NC 28031-6582
Phone
(704) 384-1775
Fax
(704) 384-1776
NPI assigned
Sep 14, 2012
Last updated
Feb 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Mr. Geoffrey K Gardner
Title
VP Finance
Phone
(704) 384-9094

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

19485 Old Jetton Rd
Suite 100
Cornelius, NC 28031-6582

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other names 1

  • Novant Health Lakeside Family Physicians Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Specialty503 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1730439944",
    "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": "19485 OLD JETTON RD",
            "address_2": "SUITE 100",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316582",
            "telephone_number": "704-384-1775",
            "fax_number": "704-384-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "704-384-9094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Lakeside Family Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; 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.