1649681842 NPI number — VASCULAR VEIN & IMAGING CENTER

Table of content: (NPI 1649681842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649681842 NPI number — VASCULAR VEIN & IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR VEIN & IMAGING CENTER
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:
1649681842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2281 W 24TH ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364-6154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-276-4293
Provider Business Mailing Address Fax Number:
928-276-4239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2899 S HOPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-7487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-276-4293
Provider Business Practice Location Address Fax Number:
928-276-4239
Provider Enumeration Date:
05/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MINKUS
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
928-276-4293

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  33081 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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