Provider Demographics
NPI:1508230608
Name:WAYNE HEALTH VASCULAR AND VEIN CENTER LLC
Entity Type:Organization
Organization Name:WAYNE HEALTH VASCULAR AND VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-587-4081
Mailing Address - Street 1:208 COX BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9414
Mailing Address - Country:US
Mailing Address - Phone:919-587-3333
Mailing Address - Fax:919-587-3334
Practice Address - Street 1:208 COX BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9414
Practice Address - Country:US
Practice Address - Phone:919-587-3333
Practice Address - Fax:919-587-3334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYNE HEALTH PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002012142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty