Provider Demographics
NPI:1720835408
Name:NOVANT HEALTH LAKE NORMAN MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:NOVANT HEALTH LAKE NORMAN MEDICAL CENTER, LLC
Other - Org Name:NOVANT HEALTH LAKE NORMAN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & PRESIDENT NHPMC & GCM
Authorized Official - Prefix:
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT NOVANT HEA
Authorized Official - Phone:704-384-9656
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:
Practice Address - Street 1:171 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9500
Practice Address - Country:US
Practice Address - Phone:704-660-4010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit