Healthcare Provider Details

I. General information

NPI: 1821909755
Provider Name (Legal Business Name): NOVANT HEALTH NORTHERN REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 S SOUTH ST
MOUNT AIRY NC
27030-4428
US

IV. Provider business mailing address

2085 FRONTIS PLAZA BLVD FL 3
WINSTON SALEM NC
27103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-8448
  • Fax:
Mailing address:
  • Phone: 336-277-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY EUART
Title or Position: FACILITY CREDENTIALING
Credential:
Phone: 336-277-8757