Provider Demographics
NPI:1063463156
Name:NOVANT HEALTH MATTHEWS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:NOVANT HEALTH MATTHEWS MEDICAL CENTER LLC
Other - Org Name:NOVANT HEALTH MATTHEWS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9261
Mailing Address - Street 1:101 N CHERRY ST STE 600
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4013
Mailing Address - Country:US
Mailing Address - Phone:336-277-1604
Mailing Address - Fax:336-277-9584
Practice Address - Street 1:1500 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4656
Practice Address - Country:US
Practice Address - Phone:704-384-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0270282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063463156Medicaid
NC3400171Medicaid