VIDANT MEDICAL GROUP LLC (NPI# 1639153448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639153448 |
| Entity Type | Organization |
| Organization Name | VIDANT MEDICAL GROUP LLC |
| Other Organization Name | VIDANT UROLOGY-GREENVILLE |
| Practice Address |
275 Bethesda Dr Greenville NC 27834-7217 |
| Practice Telephone | 2527525077 |
| Practice Fax Number | 2527529544 |
| Mailing Telephone | 2527525077 |
| Mailing Fax Number | 2527529544 |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2019-09-11 |
| Authorized Official Name | MRS. CARRILEE D ANDREU-NEEL (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 2528161137 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CLIA ID | 34D0934367 | 01 | |
| NC | BLUE CROSS BLUE SHIELD | 01688 | 01 |
| NC | 8901688 | 05 |
| Other Name | Type Code |
|---|---|
| Vidant Urology-Greenville | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376049619 | Vidant Medical Group LLC | Clinic/Center | 701 Doctors Dr Ste N, Kinston, NC 28501-1584 | 2018-04-04 |
| 1659742690 | Vidant Medical Group LLC | Non-Pharmacy Dispensing Site | 226 Academy St S, Ahoskie, NC 27910-2451 | 2015-10-16 |
| 1477648731 | Vidant Medical Group LLC | Clinic/Center | 2100 Stantonsburg Rd, Greenville, NC 27834-2818 | 2006-10-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Vidant Medical Group LLC | 800 W H Smith Blvd., Greenville, NC 27834 |
| Street Address |
275 BETHESDA DR |
| City | GREENVILLE |
| State | NC |
| Zip Code | 27834-7217 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194712604 | Steven Preston Benson | Physician Assistant | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2005-09-29 |
| 1972153401 | Ashley Schneider | Nurse Practitioner | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2019-09-17 |
| 1356991251 | Rachael Baker | Physician Assistant | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2019-09-13 |
| 1194270207 | Frank Ancheta Quinto Jr. | Nurse Practitioner | 275 Bethesda Dr, Eastern Urological Associates, Greenville, NC 27834-7217 | 2016-08-18 |
| 1649392853 | Matthew Alan Collins | Urology | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2007-04-06 |
| 1609965508 | Jonathan Nathaniel Hamilton | Urology | 275 Bethesda Dr, Eastern Urological Associates, P.a., Greenville, NC 27834-7217 | 2006-10-11 |
| 1699861096 | Caroline Dorothea Ames | Urology | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2006-10-04 |
| 1609888551 | Wanda Currin Hancock | Physician Assistant | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2006-08-12 |
| 1750368858 | Benjamin Gerald Hines Jr. | Urology | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2005-12-29 |
| 1669459764 | Gregory Francis Murphy | Urology | 275 Bethesda Dr, Greenville, NC 27834-7217 | 2005-12-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801255 | Nicholas Mcarthur Bennett | Day Training, Developmentally Disabled Services | 302 C, Greenville, NC 27834 | 2020-08-11 |
| 1275150245 | Shelby Renee Jones | Student in an Organized Health Care Education/Training Program | East Carolina University College of Nursing, 600 Moye Blvd, Greenville, NC 27834 | 2020-06-25 |
| 1194347138 | Soban Ahmad | Student in an Organized Health Care Education/Training Program | 600 Moye Blvd., Vmc Ma Room 350. Internal Medicine Resi, Mailstop #734, Greenville, NC 27834 | 2020-05-13 |
| 1427687789 | Brandon Allen Yates | Student in an Organized Health Care Education/Training Program | 435 Clinic Drive, Greenville, NC 27834 | 2020-04-07 |
| 1144854407 | Kristen Springer Dreyfus | Marriage & Family Therapist | 2609 West Arlington Blvd Suite 106, Greenville, NC 27834 | 2020-02-26 |
| 1861038606 | Southern Surgical Outpatient Surgery Center, Pa | Clinic/Center | 2457 Emerald Place, Greenville, NC 27834 | 2019-11-26 |
| 1003460569 | Shaun Fitzpatrick | Nurse Practitioner | Physicians East, Pa 1850 W. Arlington Blvd., Greenville, NC 27834 | 2019-08-01 |
| 1649831496 | Katherine Salome Ross | Genetic Counselor, MS | 524 Moye Blvd, Greenville, NC 27834 | 2019-06-24 |
| 1477011880 | Lauren Bethune Scroggs | Counselor | 2150 West 5th Street, Health Sciences Building Mailstop 688, Greenville, NC 27834 | 2019-03-05 |
| 1669998001 | Idella's Care Home | Community/Behavioral Health | 2912 Lee Ct # 9a, Greenville, NC 27834 | 2017-08-17 |
| Find all providers in zip 27834 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790121424 | Philip Andre Fontenot Jr. | Urology | 50 Bear Dr, Greenville, SC 29605 | 2013-05-21 |
| 1588955652 | St Francis Physician Services Inc | Urology | 200 Andrews St Ste 100, Greenville, SC 29601-3974 | 2011-04-25 |
| 1578760450 | Kimberly Lynn Burgess | Urology | 15 Park Creek Dr, Greenville, SC 29605-4270 | 2007-07-02 |
| 1922021856 | Anthony John Elisco IIi | Urology | 4215 Joe Ramsey Blvd E # 203, Greenville, TX 75401-7852 | 2006-07-25 |
| 1063462836 | Donald R. Vaughan | Urology | 18 Memorial Medical Drive, Greenville, SC 29605 | 2006-05-11 |
| 1477519098 | James Howard Sandin | Urology | 4818 Welllington, Suite 4, Greenville, TX 75402 | 2006-04-22 |
| 1073574141 | Lisa Maria Cartwright | Urology | 200 Patewood Dr Ste A115, Greenville, SC 29615-3547 | 2006-03-29 |
| 1760479968 | William Patrick Springhart | Urology | 11 Park Creek Dr, Greenville, SC 29605-4270 | 2005-10-03 |
| 1124020946 | Walter P Beh | Urology | 81 N Main St, Greenville, PA 16125-1781 | 2005-08-11 |
| 1811994940 | Woodrow Wilson Long Jr. | Urology | 18 Memorial Medical Dr, Greenville, SC 29605-4452 | 2005-07-05 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 27834 |
Please comment or provide details below to improve the information on VIDANT MEDICAL GROUP LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.