STATESVILLE INTERNAL MEDICINE
NPI 1114704558
Internal Medicine in Statesville, NC

Active since September 11, 2023CLIA 34D2155291 · Waiver
738 BRYANT ST, STATESVILLE, NC 28677(704) 230-4382(704) 253-4085 Get Directions Write a Review

NPPES record last updated: October 1, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Statesville Internal Medicine NPPES

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

STATESVILLE INTERNAL MEDICINE (NPI 1114704558) is a healthcare organization registered as an internal medicine in Statesville, North Carolina and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through September 25, 2026, maintains a secondary practice location in Statesville, and lists Joanie M Cochran, Credentialing, as its authorized official.

NPPES Registry Identity

NPI1114704558
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameIREDELL PHYSICIAN NETWORK, LLC
Location Address738 BRYANT STStatesville, NC 28677-4189
Mailing AddressPo Box 896199Charlotte, NC 28289-6199 · (844) 652-0611
Fax(704) 253-4085
Organization SubpartYes
Authorized OfficialJoanie M CochranCredentialing · (336) 306-9755
Enumeration DateSeptember 11, 2023
Last NPPES UpdateOctober 1, 2024
NPPES CertifiedOctober 1, 2024
NPI 1114704558 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedClinic/Center · Multi-SpecialtyTaxonomy 261QM1300X
738 BRYANT ST, Statesville, NC 28677

Other Names 1

Doing Business AsStatesville Internal Medicine

Secondary Practice Location 1

Location 11540 E Broad St Ste BStatesville, NC 28625-4302 · Phone (704) 253-4085 · Fax (704) 253-4085

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2155291

Statesville Internal Medicine · Statesville, NC
Active · expires Sep 25, 2026
CLIA Number34D2155291
Laboratory TypePhysician Office
Certificate Effective DateSeptember 26, 2024
Certificate Expiration DateSeptember 25, 2026
Laboratory DirectorJohn C. Nicholson
Laboratory Phone(704) 230-4382
Laboratory LocationStatesville Internal Medicine738 Bryant Street, Statesville, NC 28677
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

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

Internal Medicine (Cardiovascular Disease)
738 BRYANT ST, SUITE A
STATESVILLE, NC 28677
Internal Medicine (Cardiovascular Disease)
738 BRYANT ST, SUITE A
STATESVILLE, NC 28677
Internal Medicine (Cardiovascular Disease)
738 BRYANT ST, SUITE A
STATESVILLE, NC 28677
Internal Medicine (Cardiovascular Disease)
738 BRYANT ST, SUITE A
STATESVILLE, NC 28677
Internal Medicine (Hematology & Oncology)
738 BRYANT ST
STATESVILLE, NC 28677
Internal Medicine (Hematology & Oncology)
738 BRYANT ST
STATESVILLE, NC 28677
Internal Medicine
738 BRYANT ST
STATESVILLE, NC 28677

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1114704558, enumerated as an "organization" on September 11, 2023.

The provider is located at 738 BRYANT ST STATESVILLE, NC 28677 and the phone number is (704) 230-4382.

Internal Medicine with taxonomy code 207R00000X.