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General NPI Number Information
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NPI Number | 1467571588
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Entity Type | Organization
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Legal Business Name | CONVENIENT HEALTH CARE, INCORPORATED
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 2731 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-2403
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Country | US
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Telephone | 804-733-3131
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Fax | 804-862-9136
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Provider Business Mailing Address
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Address Line | 2731 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-2403
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Country | US
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Telephone | 804-733-3131
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Fax | 804-862-9136
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Authorized Official
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Title or Position | MEDICAL DIRECTOR-OWNER
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Name | DR. STEPHEN FREDERICK VAUGHAN SR.
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Credential | M.D., RPH
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Telephone | 804-733-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101029194
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License Number State | VA
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