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General NPI Number Information
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NPI Number | 1407668908
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Entity Type | Organization
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Legal Business Name | PATRIOTMED OF NORTH CAROLINA
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2350 BENTRIDGE LN STE 400
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-0590
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Country | US
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Telephone | 480-369-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 22601 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-1326
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Country | US
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Telephone | 480-369-1270
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Fax |
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Authorized Official
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Title or Position | CHIEF STRATEGY OFFICER
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Name | MR. ROBERT SCOTT THORNOCK
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Credential |
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Telephone | 480-369-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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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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