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General NPI Number Information
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NPI Number | 1316082076
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Entity Type | Organization
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Legal Business Name | STATESVILLE PRIMARY CARE PLLC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 708 HARTNESS RD
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City | STATESVILLE
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State | NC
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Zip | 28677-3425
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Country | US
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Telephone | 704-924-9423
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Fax |
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Provider Business Mailing Address
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Address Line | 3308 PRESTON RD SUIITE 350-165
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City | PLANO
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State | TX
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Zip | 75093-7453
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Country | US
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Telephone | 704-924-9423
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ELLIOTT J VIZEL
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Credential | MD
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Telephone | 704-924-9423
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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 | 9600416
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License Number State | NC
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