1407380017 NPI number — CINCINNATI VEIN CARE SPECIALISTS, INC

Table of content: BAO QUOC TO PHARMACIST (NPI 1386370658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407380017 NPI number — CINCINNATI VEIN CARE SPECIALISTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CINCINNATI VEIN CARE SPECIALISTS, 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:
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:
1407380017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2955 PINEDA PLAZA WAY
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-7318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-252-0327
Provider Business Mailing Address Fax Number:
863-215-7085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11123 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45249-2389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-401-8485
Provider Business Practice Location Address Fax Number:
863-215-7085
Provider Enumeration Date:
04/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
863-701-4808

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35.129976 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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