1144816976 NPI number — ATLAS VEIN CARE SPECIALISTS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144816976 NPI number — ATLAS VEIN CARE SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLAS VEIN CARE SPECIALISTS PA
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:
Provider Other Organization Name Type Code:
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:
1144816976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2636 MCDONALD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT DORA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32757-4715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-554-8182
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 HIGHWAY A1A STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN HARBOUR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32937-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-978-8348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ELMIR
Authorized Official First Name:
ZAHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-978-8348

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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