Provider Demographics
NPI:1043547102
Name:JOHN BOTTSFORD
Entity Type:Organization
Organization Name:JOHN BOTTSFORD
Other - Org Name:BOTTSFORD VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BOTTSFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:864-560-7042
Mailing Address - Street 1:385 SERPENTINE DR
Mailing Address - Street 2:STE B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3018
Mailing Address - Country:US
Mailing Address - Phone:864-560-7042
Mailing Address - Fax:864-560-7084
Practice Address - Street 1:385 SERPENTINE DR
Practice Address - Street 2:STE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3018
Practice Address - Country:US
Practice Address - Phone:864-560-7042
Practice Address - Fax:864-560-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC69412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty