Provider Demographics
NPI:1043243637
Name:NORTHCROSS OBSTETRIC AND GYNECOLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:NORTHCROSS OBSTETRIC AND GYNECOLOGIC ASSOCIATES
Other - Org Name:NORTHCROSS OBSTETRIC & GYNECOLOGIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-446-8250
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:704-631-0002
Mailing Address - Fax:
Practice Address - Street 1:16455 STATESVILLE RD
Practice Address - Street 2:STE 400
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7135
Practice Address - Country:US
Practice Address - Phone:704-801-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHCROSS OBSTETRIC AND GYNECOLOGIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043243637Medicaid
NC790284YMedicaid
NC790284YMedicaid