MEDICARE: NOVANT MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669630687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:	704-384-7830

Provider Business Practice Location Address
First Line	:	2021 N MYRTLE POINT BLVD
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2224
Country	:	US
Telephone Number	:	843-663-2663
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	DINESH S PAI
Credential	:
Telephone Number	:	704-384-9104

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2009

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