Healthcare Provider Details

I. General information

NPI: 1851766885
Provider Name (Legal Business Name): LAKE NORMAN INPATIENT SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 FAIRVIEW RD
MOORESVILLE NC
28117-9500
US

IV. Provider business mailing address

319 SPRINGWOOD DR NE
VALDESE NC
28690-8710
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-4000
  • Fax:
Mailing address:
  • Phone: 828-879-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DAVID PARKER
Title or Position: COO
Credential:
Phone: 828-879-8419