VIDANT MEDICAL GROUP LLC NPI 1477648731

NPI Information

NPI: 1477648731
Provider Name: VIDANT MEDICAL GROUP LLC
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 34D1086482

Address:
2100 STANTONSBURG RD
GREENVILLE, NC
ZIP 27834
Phone: (252) 847-2181
Get Directions

VIDANT MEDICAL GROUP LLC is a multi-specialty clinic center in Greenville, NC. VIDANT MEDICAL GROUP LLC NPI is 1477648731. The provider is registered as an organization entity type.

The provider's business location address is:

2100 STANTONSBURG RD
GREENVILLE, NC
ZIP 27834-818
Phone: (252) 847-2181
Fax: (252) 847-2213

The provider's authorized official is David S. Hughes .
The authorized official title is Cfo and has the following contact phone number (252) 847-4582.

The CLIA number assigned to this NPI record is 34D1086482 - other - state medical assistance with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 10/4/2006 and was last updated on 10/3/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	OTHER	NORTH CAROLINA	MEDCOST
2	5906333	MEDICAID	NORTH CAROLINA
3	2329992	MEDICARE OSCAR/CERTIFICATION	NORTH CAROLINA
4	018YM	OTHER	NORTH CAROLINA	BLUE CROSS BLUE SHIELD
5	=========	OTHER	NORTH CAROLINA	TRI-CARE
6	5912190	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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