Healthcare Provider Details

I. General information

NPI: 1053908509
Provider Name (Legal Business Name): NOVANT HEALTH NEW HANOVER REGIONAL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

101 N CHERRY ST STE 600
WINSTON SALEM NC
27101-4013
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-5147
  • Fax: 910-815-5189
Mailing address:
  • Phone: 336-277-1604
  • Fax: 336-277-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JON KEVIN GRIFFIN
Title or Position: SVP FINANCIAL PLAN & ANALYSIS
Credential:
Phone: 704-384-4182