Provider Demographics
NPI:1972126092
Name:VAX MOBILE NC LLC
Entity Type:Organization
Organization Name:VAX MOBILE NC LLC
Other - Org Name:VAX MOBILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-275-1489
Mailing Address - Street 1:204 CRESTMONT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-7119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 CRESTMONT RIDGE DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-7119
Practice Address - Country:US
Practice Address - Phone:847-275-1489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No305S00000XManaged Care OrganizationsPoint of Service