Provider Demographics
NPI:1154609147
Name:IREDELL PHYSICIAN NETWORK LLC
Entity type:Organization
Organization Name:IREDELL PHYSICIAN NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-878-4569
Mailing Address - Street 1:1714 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3522
Mailing Address - Country:US
Mailing Address - Phone:704-768-0546
Mailing Address - Fax:
Practice Address - Street 1:1714 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3522
Practice Address - Country:US
Practice Address - Phone:704-768-0546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IREDELL PHYSICIAN NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty