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General NPI Number Information
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NPI Number | 1235198482
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Entity Type | Organization
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Legal Business Name | TALL OAKS FAMILY PRACTICE
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 798 OAK RIDGE FARM RD. SUITE A
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City | MOORESVILLE
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State | NC
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Zip | 28115
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Country | US
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Telephone | 704-658-0011
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Fax | 704-658-0012
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Provider Business Mailing Address
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Address Line | 798 OAK RIDGE FARM RD. SUITE A
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City | MOORESVILLE
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State | NC
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Zip | 28115
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Country | US
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Telephone | 704-658-0011
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Fax | 704-658-0012
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | MR. KEVIN B VANHOY
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Credential | P.A.C.
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Telephone | 704-658-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 101555
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License Number State | NC
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