MEDICARE: NOVANT HEALTH PREP II LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1952107385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVANT HEALTH PREP II LLC

Provider Business Mailing Address
First Line	:	2085 FRONTIS PLAZA BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 CARMEL EXECUTIVE PARK DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1336
Country	:	US
Telephone Number	:	704-333-0741
Fax Number	:

Authorized Official
Title or Position	:	RCS MANAGER
Name	:	LEEA JEANINE WALTON
Credential	:
Telephone Number	:	336-515-7085

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	04/21/2025

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Directions to “NOVANT HEALTH PREP II LLC ” Practice Location

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