MECKLENBURG MEDICAL GROUP (NPI# 1366768152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366768152 |
| Entity Type | Organization |
| Organization Name | MECKLENBURG MEDICAL GROUP |
| Practice Address |
1025 Morehead Medical Drive Suite 200 Charlotte NC 28204-2965 |
| Mailing Address |
Po Box 601643 Charlotte NC 28260-1643 |
| Practice Telephone | 7043028000 |
| Practice Fax Number | 7043028001 |
| Mailing Telephone | 7043028000 |
| Mailing Fax Number | 7043028001 |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2013-06-20 |
| Authorized Official Name | DANIEL L WIENS (SENIOR VICE PRESIDENT) |
| Authorized Official Telephone | 7043550648 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207RB0002X |
Internal Medicine Specialization: Obesity Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
Allopathic & Osteopathic Physicians | ||
| N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
Allopathic & Osteopathic Physicians | ||
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | MEDICAID DME | 7705294 | 01 |
| SC | E08621 | 05 | |
| NC | MEDICARE DME | 5165580006 | 01 |
| NC | 5903117 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669797536 | Mecklenburg Medical Group | Internal Medicine | 16455 Statesville Road, Suite 200, Huntersville, NC 28078-7125 | 2010-04-02 |
| 1518282581 | Mecklenburg Medical Group | Internal Medicine | 7666 Charlotte Highway, Suite 200, Indian Land, SC 29707-7001 | 2010-04-02 |
| 1831414705 | Mecklenburg Medical Group | Internal Medicine | 10650 Park Road Extension, Suite 420, Charlotte, NC 28210-8539 | 2010-04-02 |
| 1780909101 | Mecklenburg Medical Group | Internal Medicine | 15110 John J Delaney Drive, Suite 200, Charlotte, NC 28277-3545 | 2010-03-29 |
| 1629305073 | Mecklenburg Medical Group | Internal Medicine | 13640 Steelecroft Parkway, Suite 320, Charlotte, NC 28278-7565 | 2009-11-05 |
| 1477879260 | Mecklenburg Medical Group | Dermatology | 4525 Cameron Valley Pkwy, Suite 2100, Charlotte, NC 28211-4369 | 2010-04-19 |
| 1821314618 | Mecklenburg Medical Group | Internal Medicine | 200 South College Street, Suite 500, Charlotte, NC 28202-2067 | 2010-04-19 |
| 1093031882 | Mecklenburg Medical Group | Internal Medicine | 16455 Statesville Rd, Ste 200, Huntersville, NC 28078-7135 | 2010-04-19 |
| 1457677247 | Mecklenburg Medical Group | Dermatology | 1900 Brunswick Ave, Charlotte, NC 28207-1822 | 2010-04-19 |
| 1700102506 | Mecklenburg Medical Group | Internal Medicine | 10650 Park Rd, Ste 420, Charlotte, NC 28210-8538 | 2010-04-19 |
| Street Address |
1025 MOREHEAD MEDICAL DRIVE SUITE 200 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28204-2965 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053375170 | Kelly L Vanderhave | Orthopaedic Surgery | 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204-2966 | 2006-04-14 |
| 1972149946 | Christoph Tschuor | Surgery | 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204 | 2019-11-25 |
| 1720644354 | Eva Barbara Deerenberg | Surgery | 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204 | 2019-05-20 |
| 1306223425 | Daphne Louise Capek | Obstetrics & Gynecology | 1025 Morehead Medical Drive, Suite 450, Charlotte, NC 28204 | 2015-04-27 |
| 1528455243 | Patrick Moody | Orthopaedic Surgery | 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204-2966 | 2015-04-21 |
| 1114242088 | Mecklenburg Medical Group | Internal Medicine | 1025 Morehead Medical Drive, Suite 200, Charlotte, NC 28204-2965 | 2010-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285263582 | Precise Home Care Service LLC | In Home Supportive Care | 1935 Baxter Street, Unit 101, Charlotte, NC 28204 | 2020-04-07 |
| 1285276253 | Shannon Miller | Counselor | 1432 E Seventh Street, Charlotte, NC 28204 | 2019-10-11 |
| 1194282202 | Madison Joann Mcgarrigle | Behavior Technician | 1401 East 7th Street, Charlotte, NC 28204 | 2019-02-25 |
| 1255802674 | Stacey D. Alston, Dds, Pa | Dentist | 1020 E. 10th St., Suite 1, Charlotte, NC 28204 | 2018-12-11 |
| 1972082097 | Kim Webb Talbert | Nurse Practitioner | Novant Health Presbyterian Medical Center Charlotte, 200 Hawthorne Lane, Charlotte, NC 28204 | 2018-08-09 |
| 1164910535 | Jesse Elijah Roberts | Counselor | 1801 E 5th Street, #208, Charlotte, NC 28204 | 2018-05-01 |
| 1336696848 | Eight Healthcare | Exclusive Provider Organization | 2455 Weddington Ave, 2110, Charlotte, NC 28204 | 2016-09-01 |
| 1225480551 | Kathleen Quintana Bradley | Physician Assistant | 1523 Elizabeth Ave., Suite 200, Charlotte, NC 28204 | 2016-07-11 |
| 1184049777 | Della Franklin | Speech-Language Pathologist | 1021 Morehead Medical Dr Ste 3300, Charlotte, NC 28204 | 2014-02-19 |
| 1225459845 | Healing Arts Medical, Pa | Family Medicine | 335 N. Caswell Rd., Charlotte, NC 28204 | 2013-12-27 |
| Find all providers in zip 28204 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285258244 | Royal Medical Supply, Inc. | Durable Medical Equipment & Medical Supplies | 3709 Eastway Dr Ste 101, Charlotte, NC 28205-6266 | 2020-06-04 |
| 1427681667 | Prism Medical Products, L.L.C. | Durable Medical Equipment & Medical Supplies | 9635 Southern Pine Blvd Ste 100, Charlotte, NC 28273-5546 | 2020-02-17 |
| 1588204846 | Amerita South Atlantic LLC | Durable Medical Equipment & Medical Supplies | 2520 Whitehall Park Dr Ste 1000, Charlotte, NC 28273 | 2020-01-14 |
| 1710529458 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 200 Hawthorne Ln Ste T1578, Charlotte, NC 28204-2515 | 2019-10-15 |
| 1861040750 | Helen C Ananti | Durable Medical Equipment & Medical Supplies | 7401 The Plz Ste C, Charlotte, NC 28215-1925 | 2019-09-03 |
| 1407326416 | Affordable Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 7200 Albemarle Rd Ste E, Charlotte, NC 28227-8110 | 2018-12-03 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1821574955 | Jeff Gauer | Durable Medical Equipment & Medical Supplies | 9517 Monroe Rd Ste H, Charlotte, NC 28270-1489 | 2018-07-11 |
| 1871089094 | Unyq Design Inc | Durable Medical Equipment & Medical Supplies | 1776 Statesville Ave # 10117, Charlotte, NC 28206-3013 | 2018-07-11 |
| 1225524671 | Jevetta R Wade | Durable Medical Equipment & Medical Supplies | 8828 Balmoral Park Dr, Charlotte, NC 28277-1338 | 2018-07-09 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.