Provider Type Icon

SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC NPI 1144524190


NPI Information

NPI: 1144524190
Provider Name: SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC
Classification: Surgery - 208600000X
Entity Type: Organization

CLIA Number: 34D2163485

Address:
13430 HOOVER CREEK BLVD STE 200
CHARLOTTE, NC
ZIP 28273
Phone: (704) 910-8380
Get Directions

SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC is a surgery in Charlotte, NC. The provider is a general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC NPI is 1144524190. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

13430 HOOVER CREEK BLVD STE 200
CHARLOTTE, NC
ZIP 28273-054
Phone: (704) 910-8380
Fax: (704) 710-8045

The provider's authorized official is James Nelson Antezana .
The authorized official title is General And Vascular Surgeon and has the following contact phone number (803) 412-5126.

The CLIA number assigned to this NPI record is 34D2163485 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2011 and was last updated on 5/30/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208600000XSurgery2009-00158NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
159-13992MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.