NOVANT MEDICAL GROUP INC (NPI# 1912154501) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912154501 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP INC |
| Other Organization Name | NOVANT HEALTH BLACKSBURG FAMILY MEDICINE |
| Practice Address |
303 W Pine St Suite B Blacksburg SC 29702-1549 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 8648393082 |
| Practice Fax Number | 8648393064 |
| Mailing Telephone | 8644870155 |
| Mailing Fax Number | 8644870924 |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2013-05-31 |
| Authorized Official Name | GEOFFREY K. GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043849094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Blacksburg Family Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700433711 | Novant Medical Group Inc | Psychiatry & Neurology | 933 Rockford St Ste 2, Mount Airy, NC 27030-5323 | 2019-08-23 |
| 1205481009 | Novant Medical Group Inc | Dermatology | 6324 Fairview Rd # 200, Charlotte, NC 28210-3271 | 2019-08-08 |
| 1033675079 | Novant Medical Group Inc | Psychiatry & Neurology | 1918 Randolph Rd Ste 320, Charlotte, NC 28207-1109 | 2019-02-14 |
| 1205355799 | Novant Medical Group Inc | Family Medicine | 16525 Holly Crest Ln Ste 250, Huntersville, NC 28078-4912 | 2017-09-15 |
| 1679090468 | Novant Medical Group Inc | Internal Medicine | 12311 Copper Way Ste 100, Charlotte, NC 28277-3643 | 2017-08-23 |
| 1003332016 | Novant Medical Group Inc | Internal Medicine | 10030 Gilead Rd Ste 344, Huntersville, NC 28078-7545 | 2017-08-22 |
| 1255709432 | Novant Medical Group Inc | Family Medicine | 19485 Old Jetton Road, Suite 100, Cornelius, NC 28031-6583 | 2015-09-04 |
| 1215326665 | Novant Medical Group Inc | Surgery | 819 N Atlantic Ave, Southport, NC 28461-3531 | 2015-01-22 |
| 1194113662 | Novant Medical Group Inc | Obstetrics & Gynecology | 1730 Kernersville Medical Parkway, Suite 104, Kernersville, NC 27284-7198 | 2015-01-06 |
| 1437556594 | Novant Medical Group Inc | Internal Medicine | 13 Medical Campus, Suite 102, Supply, NC 28462-4093 | 2014-12-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Novant Medical Group Inc. | 2626 Glenwood Ave Ste 550, Raleigh, NC 27608 |
| Virginia Business Entities | Novant Medical Group Inc. | 2085 Frontis Plaza Blvd, Winston Salem, North Carolina 27103 |
| Street Address |
303 W PINE ST SUITE B |
| City | BLACKSBURG |
| State | SC |
| Zip Code | 29702-1549 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407020589 | Rhonda C. Bridget | Nurse Practitioner | 303 W Pine St, Suite B, Blacksburg, SC 29702-1549 | 2008-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316315054 | Jim Nasim Dmd, Pa | Dentist | 305 West Pine Street, Blacksburg, SC 29702 | 2015-09-11 |
| 1396163317 | Tammie Peterson | Licensed Practical Nurse | 402 Hardin Street, Blacksburg, SC 29702 | 2014-04-07 |
| 1861810343 | Tamera Randolph | Registered Nurse | 201 W. Ramseur Dr., Blackburg, SC 29702 | 2014-04-02 |
| 1821424045 | Healthstat On-site Clinic/milliken Allen | Preventive Medicine | 164 Milliken St, Blacksburg, SC 29702 | 2013-09-19 |
| 1942636154 | Healthstat On-site Clinic/milliken Magnolia | Preventive Medicine | 157 Milliken Rd., Blacksburg, SC 29702 | 2013-09-19 |
| 1366605214 | Leah Quirita Walden | Dentist | 2022 Cherry Road, Rock Hill, SC 29702 | 2008-07-09 |
| 1972792398 | Ron C Sisk | Chiropractor | 202 S Shelby St, Blacksburg, SC 29702 | 2007-10-22 |
| 1952347320 | Philip Edward Brafford Jr. | Chiropractor | 1742 W Cherokee Street, Blacksburg, SC 29702 | 2006-06-22 |
| 1457828329 | Supreme Management and Associates, LLC | Home Health | 107 1/2 W Cherokee St, Blacksburg, SC 29702-1501 | 2018-10-30 |
| 1518221258 | Jamie S Earls | Massage Therapist | 202 S Shelby St, Blacksburg, SC 29702-1542 | 2012-06-27 |
| Find all providers in zip 29702 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073925749 | David Woodson | Family Medicine | 215 Gilbert St, Blacksburg, VA 24060-3305 | 2014-05-28 |
| 1760743264 | Matthew Elias Mccarthy | Family Medicine | 1908 Shelor Ln, Blacksburg, VA 24060 | 2012-06-01 |
| 1548498181 | Hilary Lois | Family Medicine | 3700 S Main St Ste A, Blacksburg, VA 24060-7017 | 2009-06-22 |
| 1558550301 | Family Medicine of Blacksburg, LLC | Family Medicine | 1645 N Main St, Blacksburg, VA 24060-2554 | 2007-10-17 |
| 1649346081 | Michael Dustin Kennedy | Family Medicine | 1645 North Main Street, Blacksburg, VA 24060 | 2006-11-28 |
| 1053340281 | Academic Primary Care Associates | Family Medicine | 3708 S Main St Ste B, Blacksburg, VA 24060-7007 | 2006-07-01 |
| 1609815059 | Ellen I. Rabun | Family Medicine | 6103 Albemarle Lane, Blacksburg, VA 24060-3351 | 2006-06-04 |
| 1992756761 | Matthew Todd Beck | Family Medicine | Charles W. Schiffert Health Center, Mccomas Hall, Virginia Tech University, Blacksburg, VA 24061-0001 | 2006-05-15 |
| 1437112869 | Dominic Frasca | Family Medicine | 0140 Mccomas Hall, Virginia Tech, Blacksburg, VA 24061-0001 | 2006-04-07 |
| 1215999776 | Rodger Curtis Mattson | Family Medicine | 3700 S Main St Ste 1a, Blacksburg, VA 24060 | 2006-04-03 |
| Find all providers in BLACKSBURG | ||||
| City | BLACKSBURG |
| Zip Code | 29702 |
Please comment or provide details below to improve the information on NOVANT MEDICAL GROUP INC.
| 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.