Organization
PRESBYTERIAN BREAST CENTER LLC
Active
Other names
Presbyterian Breast Center Ballantyne
Organization subpart
No
Provider details
NPI number
Authorized official
FRED M HARGETT (EVP CFO)
(704) 384-5184
Entity
Organization
Contact information
Practice address
14215 BALLANTYNE CORPORATE PLACE, STE 140, CHARLOTTE, NC 28277-3146
(704) 384-1890
Mailing address
2085 FRONTIS PLAZA BLVD, WINSTON SALEM, NC 27103-5614
(336) 277-7226
(336) 277-9795
Taxonomy
Speciality
Code
Description
License number
State
261QR0206X
Mammography Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00191119
RAILROAD MEDICARE
—
Enumeration date
05/15/2006
Last updated
12/01/2010
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