1073861118 NPI number — NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC

Table of content: ELIGERT KALEMASI (NPI 1649855222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073861118 NPI number — NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVANT HEALTH THOMASVILLE MEDICAL CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073861118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1381 WESTGATE CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-718-1111
Provider Business Mailing Address Fax Number:
336-718-8994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1381 WESTGATE CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27103-2934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-718-1122
Provider Business Practice Location Address Fax Number:
336-718-8994
Provider Enumeration Date:
08/21/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY BUSINESS SPECIALIST
Authorized Official Telephone Number:
336-277-8780

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  11300 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1073861118 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2136464 . This is a "PK" identifier . This identifiers is of the category "OTHER".