Provider Demographics
NPI:1568673804
Name:CLUB STAFFING INC.
Entity Type:Organization
Organization Name:CLUB STAFFING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ULTRASOUND TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALLCOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-609-8095
Mailing Address - Street 1:146 HAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 HAYWOOD DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5314
Practice Address - Country:US
Practice Address - Phone:704-609-8095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital