Healthcare Provider Details

I. General information

NPI: 1154580587
Provider Name (Legal Business Name): VCG SPRING LAKE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CHAPEL HILL RD
SPRING LAKE NC
28390-2140
US

IV. Provider business mailing address

810 CHAPEL HILL RD
SPRING LAKE NC
28390-2140
US

V. Phone/Fax

Practice location:
  • Phone: 910-867-5500
  • Fax: 910-867-4120
Mailing address:
  • Phone: 910-867-5500
  • Fax: 910-867-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2863
License Number StateNC

VIII. Authorized Official

Name: MRS. JENNIFER LONG SAUNDERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-867-5500