Provider Demographics
NPI:1265402408
Name:KENDALL REID OLVEY
Entity type:Organization
Organization Name:KENDALL REID OLVEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OB GYN PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:REID
Authorized Official - Last Name:OLVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-692-7928
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28388-0749
Mailing Address - Country:US
Mailing Address - Phone:910-692-7928
Mailing Address - Fax:910-692-5962
Practice Address - Street 1:145 APPLECROSS ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28388
Practice Address - Country:US
Practice Address - Phone:910-692-7928
Practice Address - Fax:910-692-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904011Medicaid
2056496Medicare Oscar/Certification
NC5904011Medicaid