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General NPI Number Information
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NPI Number | 1326099201
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN BREAST CENTER LLC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 315 LILLINGTON AVENUE
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City | CHARLOTTE
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State | NC
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Zip | 28204
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Country | US
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Telephone | 704-384-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 603543
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City | CHARLOTTE
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State | NC
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Zip | 28260-3543
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Country | US
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Telephone | 678-393-5600
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Fax | 770-300-9018
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Authorized Official
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Title or Position | SVP FINANCE AND REVENUE CYCLE
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Name | GEOFFREY GARDNER
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Credential |
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Telephone | 336-718-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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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 | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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