MEDICARE: VEINCARE OF CENTRAL NORTH CAROLINA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	27639	NC

General Provider Information

NPI Number	:	1134300585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEINCARE OF CENTRAL NORTH CAROLINA PLLC

Provider Business Mailing Address
First Line	:	10224 DURANT RD
Second Line	:	SUITE 109
City	:	RALEIGH
State	:	NC
Zip	:	27614-6468
Country	:	US
Telephone Number	:	919-844-4444
Fax Number	:	919-803-0523

Provider Business Practice Location Address
First Line	:	10224 DURANT RD
Second Line	:	SUITE 109
City	:	RALEIGH
State	:	NC
Zip	:	27614-6468
Country	:	US
Telephone Number	:	919-844-4444
Fax Number	:	919-803-0523

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JANE S SMITH
Credential	:	MD
Telephone Number	:	919-844-4444

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	07/31/2015

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