Provider Demographics
NPI:1154083459
Name:MOUNTAIN VEIN CARE PROFESSIONAL LLC
Entity Type:Organization
Organization Name:MOUNTAIN VEIN CARE PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-471-3406
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-0450
Mailing Address - Country:US
Mailing Address - Phone:970-766-8346
Mailing Address - Fax:888-979-8915
Practice Address - Street 1:2515 FORESIGHT CIR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1018
Practice Address - Country:US
Practice Address - Phone:970-766-8346
Practice Address - Fax:888-979-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty