IREDELL PHYSICIAN NETWORK LLC (NPI# 1396070942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396070942 |
| Entity Type | Organization |
| Organization Name | IREDELL PHYSICIAN NETWORK LLC |
| Other Organization Name | LAKEVIEW OBGYN |
| Practice Address |
136 Corporate Park Dr Suite 3h Mooresville NC 28117-6959 |
| Mailing Address |
Po Box 25867 Winston Salem NC 27114-5867 |
| Practice Telephone | 7046609780 |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2010-05-12 |
| Authorized Official Name | MS. ANNA PURCELL (DIRECTOR, MANAGED CARE) |
| Authorized Official Telephone | 7048784569 |
| Is Organization Subpart | Y |
| Parent Organization Name | IREDELL PHYSICIAN NETWORK LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5913307 | 05 |
| Other Name | Type Code |
|---|---|
| Lakeview OBGYN | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154609147 | Iredell Physician Network LLC | Internal Medicine | 1714 Davie Ave, Statesville, NC 28677-3522 | 2011-07-26 |
| 1639318751 | Iredell Physician Network LLC | Family Medicine | 955 West Memorial Highway, Harmony, NC 28634-9352 | 2009-02-12 |
| 1780822288 | Iredell Physician Network LLC | Family Medicine | 136 Corporate Park Dr, Suite 3h, Mooresville, NC 28117-6959 | 2009-01-22 |
| 1487840427 | Iredell Physician Network LLC | Family Medicine | 774 Hartness Rd, Statesville, NC 28677-3376 | 2007-09-24 |
| 1578073631 | Iredell Physician Network LLC | Clinic/Center | 707 Bryant St, Statesville, NC 28677-4142 | 2017-10-03 |
| 1497139398 | Iredell Physician Network LLC | Clinic/Center | 3210 Harmony Hwy, Harmony, NC 28634-9161 | 2015-07-10 |
| 1124402946 | Iredell Physician Network LLC | Clinic/Center | 1668 Nc Highway 16 S, Taylorsville, NC 28681-6285 | 2015-07-10 |
| 1811381593 | Iredell Physician Network LLC | General Practice | 557 Brookdale Dr, Statesville, NC 28677-4107 | 2015-03-20 |
| 1235410960 | Iredell Physician Network LLC | Internal Medicine | 738 Bryant St Ste A, Statesville, NC 28677-4189 | 2011-09-08 |
| 1235433806 | Iredell Physician Network LLC | Internal Medicine | 757 Bryant St, Statesville, NC 28677-4142 | 2010-12-22 |
| Street Address |
136 CORPORATE PARK DR SUITE 3H |
| City | MOORESVILLE |
| State | NC |
| Zip Code | 28117-6959 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780822288 | Iredell Physician Network LLC | Family Medicine | 136 Corporate Park Dr, Suite 3h, Mooresville, NC 28117-6959 | 2009-01-22 |
| 1649887126 | Aaron Altamirano | Physical Therapist | 136 Corporate Park Dr, Mooresville, NC 28117-6959 | 2020-09-28 |
| 1578189270 | Ellis B Wall | Physical Therapist | 136 Corporate Park Dr, Mooresville, NC 28117-6959 | 2020-06-19 |
| 1922641539 | Isha Patel | Physical Therapist | 136 Corporate Park Dr, Mooresville, NC 28117-6959 | 2019-10-26 |
| 1063901668 | Angela Mary Tidwell | Occupational Therapist | 136 Corporate Park Dr, Mooresville, NC 28117-6959 | 2018-05-09 |
| 1679926497 | Priya Pastakia | Physical Therapist | 136 Corporate Park Dr, Mooresville, NC 28117-6959 | 2016-07-16 |
| 1366845661 | Carrie Lynne Magoulas | Physical Therapist | 136 Corporate Park Dr, Suite A, Mooresville, NC 28117-6959 | 2014-09-30 |
| 1871860767 | Saylor Physical Therapy | Exclusive Provider Organization | 136 Corporate Park Dr, Suite A, Mooresville, NC 28117-6959 | 2011-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891356648 | Teleoptometric Service, P.C. | Optometrist | 392 Talbert Rd, Mooresville, NC 28117 | 2019-06-24 |
| 1992268544 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 392 Talbert Rd., Mooresville, NC 28117 | 2019-04-10 |
| 1982178042 | Langtree Endoscopy Center, LLC | Clinic/Center | 106 Alexander Bank Drive, Suite 101, Mooresville, NC 28117 | 2019-01-11 |
| 1679044416 | May and Associates Therapy Center | Psychologist | 862 Brawley School Road, Suite 202, Mooresville, NC 28117 | 2018-12-05 |
| 1700360153 | Sabrina Chabot Hutchinson | Physical Therapist | 508 Williamson Rd, Suite 200, Mooresville, NC 28117 | 2018-09-21 |
| 1992284327 | Presbyterian Imaging Centers LLC | Radiology | 106 Langtree Village Dr # 201, Mooresville, NC 28117 | 2018-08-07 |
| 1073091310 | Jenelle Donzelli Nemeth | Registered Nurse | 102 Sapphire Drive, Mooresville, NC 28117 | 2018-07-30 |
| 1912497496 | Patsharx LLC | Pharmacy | 480 River Hwy, Suite A, Mooresville, NC 28117 | 2018-05-10 |
| 1427502434 | Counseling Service At Lake Norman, Pllc | Community/Behavioral Health | 18117 W. Catawba Avenue, Cornelius, NC 28117 | 2016-08-08 |
| 1447605928 | Renewal Counseling, Pllc | Counselor | 125 Commerce Park Rd., Suite 102, Mooresville, NC 28117 | 2016-05-03 |
| Find all providers in zip 28117 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184244881 | Carolinas Physicians Network Inc | Obstetrics & Gynecology | 150 Professional Park Dr Ste 200, Mooresville, NC 28117-5604 | 2020-04-22 |
| 1740544600 | Nicole Sharon Wellbaum | Obstetrics & Gynecology | 131 Medical Park Rd Ste 102, Mooresville, NC 28117-8523 | 2012-06-26 |
| 1477585107 | Todd Jerry Adams | Obstetrics & Gynecology | 235 Medical Park Rd, Suite 201, Mooresville, NC 28117-8545 | 2006-07-06 |
| 1174593313 | James D Wilson | Obstetrics & Gynecology | 131 Medical Park Rd, Ste 102, Mooresville, NC 28117 | 2006-01-23 |
| 1558357079 | Michael Lenwood Boothe | Obstetrics & Gynecology | 1205 Hadley Rd, Mooresville, IN 46158-1737 | 2005-09-20 |
| 1801899901 | Nicole Suzette Perry | Obstetrics & Gynecology | 100 Town Center Rd S, Ste B, Mooresville, IN 46158-2321 | 2005-05-23 |
| 1053878868 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 106 Langtree Village Dr Ste 200, Mooresville, NC 28117-7571 | 2019-02-28 |
| 1487012886 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 106 Langtree Village Drive, Suite 200, Mooresville, NC 28117 | 2016-02-01 |
| 1558708032 | Brittany E Johnson | Obstetrics & Gynecology | 1205 Hadley Rd, Mooresville, IN 46158 | 2013-05-24 |
| 1285909002 | Southside Ob/gyn P.C. | Obstetrics & Gynecology | 1205 Hadley Rd, Mooresville, IN 46158-1737 | 2012-03-12 |
| Find all providers in MOORESVILLE | ||||
| City | MOORESVILLE |
| Zip Code | 28117 |
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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.