NPIMap

Organization Active NPI

Laney Wellness Center

  • Adolescent Medicine (Family Medicine) Physician
  • Wilmington, NC
National Provider Identifier
1538414438
Registry record updated Jul 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X
Legal business name
LANEY WELLNESS CENTER
Practice address
4005 Oleander Dr
Wilmington, NC 28403-6816
Phone
(910) 790-9949
Fax
(910) 790-9455
NPI assigned
Jul 17, 2012
Organization subpart
Yes
Parent organization
WILMINGTON HEALTH ACCESS FOR TEENS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maria Van de Bovenkamp, CMA(AAMA)
Title
Director of Administration
Phone
(910) 790-9949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0000X Primary

Addresses

Primary practice location

4005 Oleander Dr
Wilmington, NC 28403-6816

Mailing address

2700 N College Rd
Wilmington, NC 28405-8816
Phone (910) 790-9949

National Provider Directory

National Provider Directory
Tax ID family
Wilmington Health Access for Teens7 organizations share this tax ID, including this one
Part of
Wilmington Health Access for Teens

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2700 N College Rd
Wilmington, NC 28405
Phone (910) 452-9503

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1538414438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 N COLLEGE RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284058816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANEY WELLNESS CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILMINGTON HEALTH ACCESS FOR TEENS, INC",
        "enumeration_date": "2012-07-17",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "VAN DE BOVENKAMP",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "910-790-9949",
        "authorized_official_credential": "CMA(AAMA)"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.