Organization
VEIN CENTER OF LAKE NORMAN PA
Active
Organization
VEIN CENTER OF LAKE NORMAN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY MOORE (BILLING MANAGER)
(512) 342-0455
Entity
Organization
Contact information
Practice address
10215 HICKORYWOOD HILL AVE, SUITE B, HUNTERSVILLE, NC 28078-3428
(704) 947-7027
Mailing address
10215 HICKORYWOOD HILL AVE, SUITE B, HUNTERSVILLE, NC 28078-3428
(704) 947-7027
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141KR
BCBS
NC
Enumeration date
07/27/2007
Last updated
07/27/2007
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