Provider Demographics
NPI:1093105942
Name:IREDELL PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:IREDELL PHYSICIAN NETWORK
Other - Org Name:STOUT INTERNAL MEDICINE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SKIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-495-3162
Mailing Address - Street 1:544 BRAWLEY SCHOOL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9392
Mailing Address - Country:US
Mailing Address - Phone:704-360-9310
Mailing Address - Fax:
Practice Address - Street 1:544 BRAWLEY SCHOOL RD
Practice Address - Street 2:SUITE C
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9392
Practice Address - Country:US
Practice Address - Phone:704-360-9310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty