SOUTH LAKE PEDIATRICS (NPI# 1740755610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740755610 |
| Entity Type | Organization |
| Organization Name | SOUTH LAKE PEDIATRICS |
| Other Organization Name | SOUTH LAKE PEDIATRICS |
| Practice Address |
1585 Forney Creek Pkwy Ste 2100 Denver NC 28037-9514 |
| Mailing Address |
Po Box 19305 Charlotte NC 28219-9305 |
| Practice Telephone | 7048013097 |
| Mailing Telephone | 7046310002 |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2020-07-16 |
| Authorized Official Name | THOMAS LAYMON (SENIOR VICE PRESIDENT) |
| Authorized Official Telephone | 7044468250 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTH LAKE PEDIATRICS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| South Lake Pediatrics | Doing Business As Name - Organization |
| South Lake Pediatrics | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295766079 | South Lake Pediatrics | Pediatrics | 9625 Northcross Center Ct, Ste 201, Huntersville, NC 28078-7348 | 2006-07-06 |
| 1619203791 | South Lake Pediatrics | Pediatrics | 9908 Couloak Dr, Ste 103, Charlotte, NC 28216-8678 | 2009-10-26 |
| Street Address |
1585 FORNEY CREEK PKWY STE 2100 |
| City | DENVER |
| State | NC |
| Zip Code | 28037-9514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912937434 | Jeffrey Kirsch | Physician Assistant | 1585 Forney Creek Pkwy, Ste 2100, Denver, NC 28037-9514 | 2006-07-03 |
| 1811517170 | Carolinas Physicians Network Inc | Family Medicine | 1585 Forney Creek Pkwy, Denver, NC 28037-9514 | 2020-04-16 |
| 1679944706 | Carolinas Physicians Network Inc | Internal Medicine | 1585 Forney Creek Pkwy, Ste 2350, Denver, NC 28037-9514 | 2015-10-15 |
| 1750720710 | Richard Kuzma | Family Medicine | 1585 Forney Creek Pkwy, Ste 2100, Denver, NC 28037-9514 | 2013-06-22 |
| 1336584796 | Carolinas Physicians Network Inc | Obstetrics & Gynecology | 1585 Forney Creek Pkwy, Ste 2200, Denver, NC 28037-9514 | 2013-04-30 |
| 1235491226 | Deanna Didiano | Family Medicine | 1585 Forney Creek Pkwy, Ste 2100, Denver, NC 28037-9514 | 2012-06-14 |
| 1598025983 | Ankur Mansukhlal Manvar | Anesthesiology | 1585 Forney Creek Pkwy, Denver, NC 28037-9514 | 2012-05-21 |
| 1174891428 | The Charlotte-mecklenburg Hospital Authority | Orthopaedic Surgery | 1585 Forney Creek Pkwy, Suite 2350, Denver, NC 28037-9514 | 2011-12-01 |
| 1457679672 | Carolinas Medical Center-northeast | Psychiatry & Neurology | 1585 Forney Creek Pkwy, Suite 2200 Northeast Neurology - Denver, Denver, NC 28037-9514 | 2010-05-12 |
| 1124359112 | The Charlotte-mecklenburg Hospital Authority | Surgery | 1585 Forney Creek Pkwy, Suite 2350, Denver, NC 28037-9514 | 2010-01-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922619253 | Patricia Marie Froneberger | Massage Therapist | 751 N Nc 16, Suite C, Denver, NC 28037 | 2020-08-11 |
| 1326682907 | Wild Hearts Counseling and Wellness, Pllc | Counselor | 7472 Waterside Loop Dr., #114, Denver, NC 28037 | 2019-11-06 |
| 1316581408 | Laura O Wesson | Counselor | 7472 Waterside Loop Road, Denver, NC 28037 | 2019-10-31 |
| 1043712854 | Bryan T. Persinger Dds Pa II | Dentist | 175 Cross Center Road, Denver, NC 28037 | 2018-03-07 |
| 1962901934 | Laura Howard Burgess | Nurse Practitioner | 6127 Highway 16 South, Denver, NC 28037 | 2018-02-06 |
| 1649786716 | Vip Healthcare, Pllc | Internal Medicine | 294 Highway 16 N, Suite C, Denver, NC 28037 | 2017-12-27 |
| 1265944599 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 513 Brentwood Rd, Denver, NC 28037 | 2017-10-26 |
| 1831548106 | Christina Gliwa | Dentist | 175 Cross Center Rd, Denver, NC 28037 | 2016-06-08 |
| 1629340666 | Andrea E Garmon | Pharmacist | 6050 South North Carolina Highway 16, Denver, NC 28037 | 2012-02-07 |
| 1376830729 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 7385 Nc 73 Hwy, Denver, NC 28037 | 2011-07-06 |
| Find all providers in zip 28037 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932715323 | Healthone Clinic Services - Pediatric Specialties LLC | Pediatrics | 2055 N High St Ste 330, Denver, CO 80205-5545 | 2020-09-21 |
| 1184230591 | Healthone Clinic Services - Pediatric Specialties LLC | Pediatrics | 2055 N High St Ste 360, Denver, CO 80205-5666 | 2020-09-21 |
| 1992310627 | Carolinas Physicians Network Inc | Pediatrics | 1585 Forney Creek Pkwy Ste 2100, Denver, NC 28037-9520 | 2020-09-10 |
| 1275186470 | Pediatrics At Cherry Creek,llc | Pediatrics | 3401 Quebec St Ste 3900, Denver, CO 80207-2344 | 2019-07-17 |
| 1134781057 | Lighthouse Complex Care Ltd | Pediatrics | 1240 S Parker Rd Ste 100, Denver, CO 80231-2177 | 2019-07-01 |
| 1306307665 | Stapleton Pediatrics | Pediatrics | 1258 S Pearl St Ste 110, Denver, CO 80210-1538 | 2019-03-28 |
| 1033683917 | Jenna Elizabeth Mtui | Pediatrics | 1535 W 43rd Ave, Denver, CO 80211-2425 | 2019-01-14 |
| 1275029712 | Caitlin Comerford | Pediatrics | 1601 E 19th Ave Ste 6600, Denver, CO 80218-1292 | 2018-07-09 |
| 1497286439 | Kimberly Lauren Mickey | Pediatrics | 1625 N Marion St, Denver, CO 80218-1514 | 2017-03-22 |
| 1811350341 | Lauren Ashley Welch | Pediatrics | 2650 18th Street Suite 100, Denver, CO 80211 | 2016-04-01 |
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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.