1437524683 NPI number — THE VEIN INSTITUTE, PC

Table of content: (NPI 1437524683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437524683 NPI number — THE VEIN INSTITUTE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VEIN INSTITUTE, PC
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:
1437524683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 COWART ST
Provider Second Line Business Mailing Address:
STE 321
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37408-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-551-8346
Provider Business Mailing Address Fax Number:
423-551-8347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 COWART ST
Provider Second Line Business Practice Location Address:
STE 321
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37408-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-551-8346
Provider Business Practice Location Address Fax Number:
423-551-8347
Provider Enumeration Date:
12/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-551-8346

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103G700982 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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