Healthcare Provider Details

I. General information

NPI: 1700385846
Provider Name (Legal Business Name): THE PRESBYTERIAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD STE 820
CHARLOTTE NC
28207-1119
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-5140
  • Fax: 704-316-5141
Mailing address:
  • Phone: 704-316-5140
  • Fax: 704-316-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200800578
License Number StateNC

VIII. Authorized Official

Name: GEOFFREY K GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 704-384-7606