1194099622 NPI number — TRINITY VEIN INSTITUTE PLLC

Table of content: (NPI 1194099622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194099622 NPI number — TRINITY VEIN INSTITUTE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY VEIN INSTITUTE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERICAN VEIN & VASCULAR INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194099622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7268
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80537-0268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-663-2742
Provider Business Mailing Address Fax Number:
970-667-0847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 W MAYFIELD RD
Provider Second Line Business Practice Location Address:
STE 407
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-999-8346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GIBBS
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
682-999-8346

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  P3724 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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