Provider Demographics
NPI:1639987431
Name:VITACORE LLC
Entity type:Organization
Organization Name:VITACORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-690-6894
Mailing Address - Street 1:375 SE BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6057
Mailing Address - Country:US
Mailing Address - Phone:910-690-6894
Mailing Address - Fax:910-725-0033
Practice Address - Street 1:375 SE BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6057
Practice Address - Country:US
Practice Address - Phone:910-690-6894
Practice Address - Fax:910-725-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty