Organization
PRESBYTERIAN BREAST CENTER, LLC
Active
Other names
Presbyterian Breast Center at Huntersville
Organization subpart
No
Provider details
NPI number
Authorized official
FRED M HARGETT (EVP CFO)
(704) 384-5184
Entity
Organization
Contact information
Practice address
10030 GILEAD RD, STE 310 PHYSICIANS PLAZA, HUNTERSVILLE, NC 28078-7545
(704) 316-5535
Mailing address
2085 FRONTIS PLAZA BLVD, WINSTON-SALEM, NC 27103-5614
(336) 277-7226
(336) 277-9795
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0206X
Mammography Clinic/Center
Primary
—
—
293D00000X
Physiological Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-02288
UHC
—
01
—
2881786B
MEDICARE PTAN
NC
05
—
5917803
—
NC
01
—
615320501
NC DOL
NC
01
—
P00191119
RAILROAD MEDICARE
—
Enumeration date
05/16/2006
Last updated
04/01/2013
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