=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649156191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVANT HEALTH MIDTOWN OUTPATIENT SURGERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1918 RANDOLPH RD STE 740
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28207-1167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-316-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2085 FRONTIS PLAZA BLVD
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-5614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-277-8757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP ASC OPERATIONS
-----------------------------------------------------
Name | ANDREA SMITH-JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-907-3705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------