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General NPI Number Information
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NPI Number | 1154580587
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Entity Type | Organization
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Legal Business Name | VCG SPRING LAKE INC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 810 CHAPEL HILL RD
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City | SPRING LAKE
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State | NC
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Zip | 28390-2140
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Country | US
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Telephone | 910-867-5500
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Fax | 910-867-4120
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Provider Business Mailing Address
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Address Line | 810 CHAPEL HILL RD
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City | SPRING LAKE
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State | NC
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Zip | 28390-2140
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Country | US
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Telephone | 910-867-5500
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Fax | 910-867-4120
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JENNIFER LONG SAUNDERS
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Credential |
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Telephone | 910-867-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2863
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License Number State | NC
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