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General NPI Number Information
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NPI Number | 1194953307
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Entity Type | Organization
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Legal Business Name | IREDELL PHYSICIAN NETWORK LLC
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 365 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4103
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Country | US
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Telephone | 704-872-3630
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Fax | 704-872-0049
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Provider Business Mailing Address
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Address Line | 365 BROOKDALE DR
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City | STATESVILLE
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State | NC
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Zip | 28677-4103
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Country | US
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Telephone | 704-872-3630
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Fax | 704-872-0049
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ANNA PURCELL
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Credential |
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Telephone | 704-878-4569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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