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General NPI Number Information
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NPI Number | 1134300585
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Entity Type | Organization
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Legal Business Name | VEINCARE OF CENTRAL NORTH CAROLINA PLLC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 10224 DURANT RD SUITE 109
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City | RALEIGH
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State | NC
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Zip | 27614-6468
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Country | US
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Telephone | 919-844-4444
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Fax | 919-803-0523
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Provider Business Mailing Address
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Address Line | 10224 DURANT RD SUITE 109
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City | RALEIGH
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State | NC
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Zip | 27614-6468
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Country | US
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Telephone | 919-844-4444
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Fax | 919-803-0523
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JANE S SMITH
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Credential | MD
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Telephone | 919-844-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 27639
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License Number State | NC
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