Organization
PRESBYTERIAN BREAST CENTER LLC
Active
Other names
Novant Health Breast Center
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY GARDNER (SVP FINANCE AND REVENUE CYCLE)
(336) 718-2078
Entity
Organization
Contact information
Practice address
315 LILLINGTON AVENUE, CHARLOTTE, NC 28204
(704) 384-5000
Mailing address
PO BOX 603543, CHARLOTTE, NC 28260-3543
(678) 393-5600
(770) 300-9018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
293D00000X
Physiological Laboratory
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-42372
UHC
—
01
—
615320500
NC DOL
NC
05
—
89016K8
—
NC
Enumeration date
05/15/2006
Last updated
03/20/2024
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