Healthcare Provider Details

I. General information

NPI: 1760771778
Provider Name (Legal Business Name): HEALTHMED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8821 UNIVERSITY EAST DRIVE SUITE 105
CHARLOTTE NC
28213-4201
US

IV. Provider business mailing address

8821 UNIVERSITY EAST DRIVE SUITE 105
CHARLOTTE NC
28213-4201
US

V. Phone/Fax

Practice location:
  • Phone: 704-599-0900
  • Fax: 704-599-0998
Mailing address:
  • Phone: 704-599-0900
  • Fax: 704-599-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36117
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5005092
License Number StateNC

VIII. Authorized Official

Name: NEIL PAI
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-599-0900