Organization
IREDELL PHYSICIAN NETWORK LLC
Active
Parent organization
IREDELL PHYSICIAN NETWORK LLC
Other names
Lakeview OBGYN
Organization subpart
Yes
Provider details
NPI number
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Authorized official
MS. ANNA PURCELL (DIRECTOR, MANAGED CARE)
(704) 878-4569
Entity
Organization
Contact information
Practice address
136 CORPORATE PARK DR, SUITE 3H, MOORESVILLE, NC 28117-6959
(704) 660-9780
Mailing address
PO BOX 25867, WINSTON SALEM, NC 27114-5867
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5913307
—
NC
Enumeration date
10/14/2009
Last updated
05/12/2010
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