Basic Information
| Provider Information | |||||||||
| NPI: | 1801866140 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISBURG NOVANT LLC | ||||||||
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| OtherOrganizationName: | NOVANT HEALTH FRANKLIN MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2085 FRONTIS PLAZA BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271035614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194965131 | ||||||||
| FaxNumber: | 9194963689 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | LOUISBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275492256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194965131 | ||||||||
| FaxNumber: | 9194963689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 04/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | HARGETT | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7043845184 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 80261 | NC | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 3400036 | 05 | NC | MEDICAID |