| Renew Health South | |
|
6406 Carmel Rd Ste 304 Charlotte NC 28226-8267 | |
| (704) 541-6000 | |
| (704) 541-3350 |
| Full Name | Renew Health South |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 6406 Carmel Rd Ste 304, Charlotte, North Carolina |
| Authorized Official Name and Position | Micah Kirscher (OWNER) |
| Authorized Official Contact | 7043101175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Health South 6406 Carmel Rd Ste 304 Charlotte NC 28226-8267 Ph: (704) 541-6000 | Renew Health South 6406 Carmel Rd Ste 304 Charlotte NC 28226-8267 Ph: (704) 541-6000 |
| NPI Number | 1619548237 |
|---|---|
| Provider Enumeration Date | 07/06/2021 |
| Last Update Date | 12/30/2021 |
| Medicare PECOS PAC ID | 5395148233 |
|---|---|
| Medicare Enrollment ID | O20210729001401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619548237 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
| Provider Name | Todd Lockhart |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1053369587 PECOS PAC ID: 1759489933 Enrollment ID: I20101202000518 |
| Provider Name | Johnny B Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326488875 PECOS PAC ID: 0840433108 Enrollment ID: I20130905000588 |
| Provider Name | Micah Kirscher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821546326 PECOS PAC ID: 4880974005 Enrollment ID: I20161206000470 |
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