Provider Demographics
NPI:1093869265
Name:MESQUITE VEIN AND LASER, INC
Entity Type:Organization
Organization Name:MESQUITE VEIN AND LASER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-346-8346
Mailing Address - Street 1:350 FALCON RIDGE PKWY STE 501
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8880
Mailing Address - Country:US
Mailing Address - Phone:702-346-8346
Mailing Address - Fax:702-346-5999
Practice Address - Street 1:350 FALCON RIDGE PARKWAY
Practice Address - Street 2:#501
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8849
Practice Address - Country:US
Practice Address - Phone:702-346-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty