Provider Demographics
NPI:1154580587
Name:VCG SPRING LAKE INC
Entity type:Organization
Organization Name:VCG SPRING LAKE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-867-5500
Mailing Address - Street 1:810 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2140
Mailing Address - Country:US
Mailing Address - Phone:910-867-5500
Mailing Address - Fax:910-867-4120
Practice Address - Street 1:810 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2140
Practice Address - Country:US
Practice Address - Phone:910-867-5500
Practice Address - Fax:910-867-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2863261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0849YOtherBLUE CROSS BLUE SHIELD
NC890849YMedicaid
NC2454148Medicare UPIN