# MOORESVILLE PPM LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOORESVILLE PPM LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700028982
- **Legal business name:** MOORESVILLE PPM LLC
- **Authorized official:** MRS. JENNIFER L JACKSON (SR DIR PROV ENROLLMENT & ONBOARDING)
- **Authorized official phone:** (615) 465-3334

## Contact information

- **Practice address:** 131 MEDICAL PARK RD, SUITE 302, MOORESVILLE, NC 28117-8522
- **Practice address phone:** (704) 660-4750
- **Mailing address:** 4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
- **Mailing address phone:** (615) 465-7000
- **Mailing address fax:** (615) 628-6877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | 22538 | NC | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | — |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | NULL | — |
| 207XS0117X | Orthopaedic Surgery of the Spine Physician | — | — | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/02/2009
- **Last updated:** 01/14/2022