NPI |
1780163766 |
The fax number associated with the location
address of the provider being identified. |
Entity Type Code |
2 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Employer Identification Number EIN |
|
The date that a record was last updated or changed. |
Provider Organization Name Legal Business Name |
NOVANT MEDICAL GROUP, INC. |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Other Organization Name |
NOVANT HEALTH SPINE SPECIALISTS |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
1910 JAKE ALEXANDER BLVD W STE 102 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
SALISBURY |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NC |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
281471163 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
7046372409 |
|
Provider Business Practice Location Address Fax Number |
7046372552 |
|
Provider Enumeration Date |
8/9/2018 |
|
Last Update Date |
7/12/2023 |
|
Authorized Official Last Name |
WALTON |
|
Authorized Official First Name |
LEEA |
|
Authorized Official Middle Name |
JEANINE |
The middle name of the authorized official. |
Authorized Official Title or Position |
RCS MANAGER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
7043166081 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
207XS0117X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|
NPI Certification Date |
7/12/2023 |
|