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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