Organization
NOVANT HEALTH MEDICAL GROUP, LLC
Active
Other names
Novant Health Surgical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (RCS MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
257 HOSPITAL DRIVE SUITE 200, BOLIVIA, NC 28422-8411
(910) 721-4000
(910) 721-4001
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 721-4000
(910) 721-4001
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018M5
BCBS-NC
NC
05
—
5905547
—
NC
01
—
CC5118
RAILROAD MEDICARE
NC
05
—
NPB268
—
SC
Enumeration date
10/16/2006
Last updated
06/24/2024
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