1780769224 NPI number — VEIN& COSMETIC SOLUTIONS

Table of content: (NPI 1780769224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780769224 NPI number — VEIN& COSMETIC SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEIN& COSMETIC SOLUTIONS
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:
VEIN & COSMETIC SOLUTIONS
Provider Other Organization Name Type Code:
4
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:
1780769224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7626 TIMBERLAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-2325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-847-5347
Provider Business Mailing Address Fax Number:
434-316-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7626 TIMBERLAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-847-5347
Provider Business Practice Location Address Fax Number:
434-316-7008
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIDMEYER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
434-847-5347

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101049993 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7187888 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 429868 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 176753 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: DD5891 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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