Vidant Medical Group LLC
Organization Active NPI Urology Physician · Greenville, NC
NPI 1639153448 · NPPES record last updated Sep 11, 2019
Key facts
- NPI
- 1639153448
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- VIDANT MEDICAL GROUP LLC
- Practice address
- 275 Bethesda Dr
Greenville, NC 27834-7217 - Phone
- (252) 752-5077
- Fax
- (252) 752-9544
- NPI assigned
- Dec 5, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Carrilee D Andreu-Neel
- Title
- Practice Administrator
- Phone
- (252) 816-1137
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Vidant Medical Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | NC | Yes |
Addresses
Primary practice location
275 Bethesda Dr
Greenville, NC 27834-7217
Mailing address
275 Bethesda Dr
Greenville, NC 27834-7217
Phone (252) 752-5077
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8901688 | Medicaid | NC | |
| 01688 | Other | NC | BLUE CROSS BLUE SHIELD |
| 34D0934367 | Other | CLIA ID |
Other names
- Vidant Urology-Greenville
Other providers in Greenville, NC
- Susan Burch Vick
- Virginia McRoy Vickery
- Jacquelin N Victory
- Vidant Medical Group Affiliates LLC
- Vidant Medical Group LLC
- Vidant Radiation Oncology LLC
- Sean Carl Vidulich
- Alexandre Rezende Vieira
- Marleni Vilca-Paul
- Marlen Del Rocio Villegas Garcia
All providers in Greenville, NC · Urology Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.