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MOORESVILLE PPM, LLC
NPI 1003567082
Internal Medicine - Interventional Cardiology in Statesville, NC

Active since January 12, 2022
1424 FERN CREEK DR STE D, STATESVILLE, NC 28625(704) 878-2058(704) 872-6576 Get Directions Write a Review

NPPES record last updated: January 12, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mooresville Ppm, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOORESVILLE PPM, LLC (NPI 1003567082), doing business as Lake Norman Medical Group Heart & Vascular Statesville, is a healthcare organization registered as an interventional cardiology in Statesville, North Carolina and active in the NPI registry since January 2022. The organization lists Jennifer L Jackson, Sr Dir Prov Enroll & Onboarding, as its authorized official.

NPPES Registry Identity

NPI1003567082
Entity TypeOrganization
Primary Taxonomy207RI0011X
Legal Business NameMOORESVILLE PPM, LLC
Location Address1424 FERN CREEK DR STE DStatesville, NC 28625-9376
Mailing AddressPo Box 689022Franklin, TN 37068-9022 · (615) 465-7230 · Fax (615) 628-6677
Phone(704) 878-2058
Fax(704) 872-6576
Organization SubpartYes
Authorized OfficialJennifer L JacksonSr Dir Prov Enroll & Onboarding · (615) 465-3334
Enumeration DateJanuary 12, 2022
NPPES CertifiedJanuary 12, 2022
✔ NPI 1003567082 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Interventional CardiologyAllopathic & Osteopathic Physicians
Taxonomy Code207RI0011X
Definition
An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.
1424 FERN CREEK DR STE D, Statesville, NC 28625
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Other Names 1

Doing Business AsLake Norman Medical Group Heart & Vascular Statesville

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAVID V KELLER PA-C
Physician Assistant
1424 FERN CREEK DR STE D
STATESVILLE, NC 28625
Iredell County (704) 878-2058
STATESVILLE HMA MEDICAL GROUP, LLC
Internal Medicine
1424 FERN CREEK DR STE D
STATESVILLE, NC 28625
Iredell County (704) 838-7080
MS. CLAUDIA LYN BURKHALTER FNP
Nurse Practitioner (Family)
1424 FERN CREEK DR STE D
STATESVILLE, NC 28625
Iredell County (704) 838-7080

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mooresville Ppm, LLC's NPI number?

The NPI number for Mooresville Ppm, LLC is 1003567082. It was assigned to this organization in the NPPES registry on January 12, 2022. The provider is doing business as Lake Norman Medical Group Heart & Vascular Statesville.

Where is Mooresville Ppm, LLC located?

Mooresville Ppm, LLC is located at 1424 Fern Creek Dr Ste D, Statesville, NC 28625. The listed phone number is (704) 878-2058.

What is Mooresville Ppm, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Interventional Cardiology, with taxonomy code 207RI0011X.

When was this NPI record last updated?

The NPPES record for Mooresville Ppm, LLC was last updated on January 12, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.