Provider Demographics
NPI:1033466495
Name:VARICOSE VEIN TREATMENT CENTER
Entity Type:Organization
Organization Name:VARICOSE VEIN TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-325-2341
Mailing Address - Street 1:3209 W FULLERTON PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4060
Mailing Address - Country:US
Mailing Address - Phone:812-325-2341
Mailing Address - Fax:
Practice Address - Street 1:3209 W FULLERTON PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4060
Practice Address - Country:US
Practice Address - Phone:812-325-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-04
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty