Provider Demographics
NPI:1528386711
Name:MEDASSIST OF MECKLENBURG
Entity Type:Organization
Organization Name:MEDASSIST OF MECKLENBURG
Other - Org Name:NC MEDASSIST LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-536-1790
Mailing Address - Street 1:5516 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-2708
Mailing Address - Country:US
Mailing Address - Phone:704-536-1790
Mailing Address - Fax:704-536-9865
Practice Address - Street 1:5516 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-2708
Practice Address - Country:US
Practice Address - Phone:704-536-1790
Practice Address - Fax:704-536-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07100333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy