Basic Information
| Provider Information | |||||||||
| NPI: | 1235401795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHCROSS HEALTH MAINTENANCE P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4922 ALBEMARLE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282056618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045682900 | ||||||||
| FaxNumber: | 7045680164 | ||||||||
| Practice Location | |||||||||
| Address1: | 4922 ALBEMARLE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282056618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045682900 | ||||||||
| FaxNumber: | 7045680164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2012 | ||||||||
| LastUpdateDate: | 01/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | LE | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7048066197 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.