Novant Health Medical Group Coastal Region, LLC
Organization Active NPI Obstetrics & Gynecology Physician · Wilmington, NC
NPI 1962097006 · NPPES record last updated Jul 19, 2021
Key facts
- NPI
- 1962097006
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
- Practice address
- 2150 Shipyard Blvd
Wilmington, NC 28403-8052 - Phone
- (910) 662-9480
- Fax
- (910) 332-5666
- NPI assigned
- Mar 1, 2021
- Organization subpart
- No
Authorized official
- Name
- Shala Davis
- Title
- RCS Manager
- Phone
- (704) 303-7517
Corporate family (same tax ID) 13
Practitioners 7
-
Caroline Jane Brower, PA-C
-
Edith Mintz, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210408000285 | NC | Part B Supplier - Clinic/Group Practice | 2860809936 |
Receives reassigned benefits from 798 practitioners This NPI is an additional NPI on the enrollment Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC… |
National Provider Directory
- Tax ID family
- Novant Health Medical Group Coastal Region LLC
Locations
1520 Physicians Dr
Wilmington, NC 28401
Phone (910) 662-8300
2150 Shipyard Blvd
Wilmington, NC 28403
Phone (910) 662-9300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | Yes |
Addresses
Primary practice location
2150 Shipyard Blvd
Wilmington, NC 28403-8052
Mailing address
PO Box 936857
Atlanta, GA 31193-6857
Other names
- NHMGCR AFM
Other providers in Wilmington, NC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group NC Coastal Region Specialty, LLC
- Novant Health Medical Group NC Coastal Region Specialty, LLC
- Novant Health New Hanover Regional Medical Center LLC
All providers in Wilmington, 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 Jul 19, 2021. 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.