Organization
MECKLENBURG MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS FORD LAYMON (SENIOR VICE PRESIDENT)
(704) 631-0002
Entity
Organization
Contact information
Practice address
1550 FAULK ST, SUITE 1500, MONROE, NC 28112-5086
(704) 302-9700
(704) 302-9701
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-9700
(704) 302-9701
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5914037
—
NC
01
—
7705296
MEDICAID DME
NC
05
—
NPB352
—
SC
Enumeration date
12/18/2009
Last updated
08/12/2016
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