Provider Demographics
NPI:1073712337
Name:DOCTORS VITAL CARE AND SCREENING, PLLC
Entity Type:Organization
Organization Name:DOCTORS VITAL CARE AND SCREENING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:POONAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-740-2864
Mailing Address - Street 1:150 N STEELE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-3918
Mailing Address - Country:US
Mailing Address - Phone:919-776-7255
Mailing Address - Fax:919-776-5011
Practice Address - Street 1:150 N STEELE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-3918
Practice Address - Country:US
Practice Address - Phone:919-776-7255
Practice Address - Fax:919-776-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102462261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2177890AMedicare PIN
NCS64933Medicare UPIN