MEDICARE: NOVANT MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207T00000X	Neurological Surgery Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	208VP0000X	Pain Medicine Physician
4	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114366994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-7840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 MATTHEWS TOWNSHIP PARKWAY
Second Line	:	SUITE 355
City	:	MATTHEWS
State	:	NC
Zip	:	28105-4300
Country	:	US
Telephone Number	:	704-544-6920
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCE
Name	:	MR. GEOFFREY KEITH GARDNER
Credential	:
Telephone Number	:	704-544-6920

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	03/27/2014

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Directions to “NOVANT MEDICAL GROUP INC ” Practice Location

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