Basic Information
| Provider Information | |||||||||
| NPI: | 1053908509 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 N CHERRY ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271014013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362771604 | ||||||||
| FaxNumber: | 3362779584 | ||||||||
| Practice Location | |||||||||
| Address1: | 2131 S 17TH ST | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106675147 | ||||||||
| FaxNumber: | 9108155189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2020 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRIFFIN | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | KEVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP FINANCIAL PLAN & ANALYSIS | ||||||||
| AuthorizedOfficialTelephone: | 7043844182 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | N | Suppliers | Pharmacy | Community/Retail Pharmacy | 3336S0011X | N | Suppliers | Pharmacy | Specialty Pharmacy | 333600000X | Y | Suppliers | Pharmacy |
No ID Information.