Organization
THE PRESBYTERIAN HOSPITAL
Active
Other names
Novant Health Senior Care
Organization subpart
No
Provider details
NPI number
Authorized official
AMY VANCE (SVP & COO OF PHC)
(704) 384-7606
Entity
Organization
Contact information
Practice address
6324 FAIRVIEW RD, SUITE 310, CHARLOTTE, NC 28210-4172
(704) 316-6565
(704) 316-6560
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-6565
(704) 316-6560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NC
207R00000X
Internal Medicine Physician
—
NC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02246
BCBS NC
NC
05
—
89012M7
—
NC
01
—
CG8809
RAILROAD MEDICARE
NC
05
—
NPA925
—
SC
Enumeration date
05/19/2006
Last updated
07/05/2013
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