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General NPI Number Information
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NPI Number | 1205748928
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Entity Type | Organization
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Legal Business Name | NOVANT HEALTH NORTHERN REGIONAL MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 314 SOUTH STREET MEDICAL PARK STE 100
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City | MOUNT AIRY
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State | NC
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Zip | 27030-4599
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Country | US
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Telephone | 336-719-7129
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 FRONTIS PLAZA BLVD FL 3
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5614
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Country | US
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Telephone | 336-277-8757
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Fax |
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Authorized Official
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Title or Position | FACILITY CREDENTIALING
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Name | BEVERLY EUART
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Credential |
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Telephone | 336-277-8757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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