Provider Demographics
NPI:1710043237
Name:VPC INC
Entity Type:Organization
Organization Name:VPC INC
Other - Org Name:VIDALIA PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PRACTICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:912-537-9355
Mailing Address - Street 1:303 HARRIS INDUSTRIAL BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8854
Mailing Address - Country:US
Mailing Address - Phone:912-537-9355
Mailing Address - Fax:912-335-4804
Practice Address - Street 1:414 LUGENIA DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7210
Practice Address - Country:US
Practice Address - Phone:912-537-9355
Practice Address - Fax:912-537-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty