1740579481 NPI number — VEIN CARE SPECIALISTS OF SOUTH FLORIDA, INC

Table of content: (NPI 1740579481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740579481 NPI number — VEIN CARE SPECIALISTS OF SOUTH FLORIDA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEIN CARE SPECIALISTS OF SOUTH FLORIDA, INC
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:
DR MARK J MARZANO MD
Provider Other Organization Name Type Code:
5
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:
1740579481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2338 IMMOKALEE RD
Provider Second Line Business Mailing Address:
STE 116
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34110-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-384-9480
Provider Business Mailing Address Fax Number:
239-384-9681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 TAMIAMI TRL N
Provider Second Line Business Practice Location Address:
STE 204
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-430-8346
Provider Business Practice Location Address Fax Number:
239-384-9681
Provider Enumeration Date:
04/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARZANO
Authorized Official First Name:
MARK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
239-430-8346

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME81325 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51707 . This is a "BLUE CROSS BLUE SHIELD PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 260090100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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