Provider Demographics
NPI:1225136351
Name:VEIN ESSENTIALS PLLC
Entity Type:Organization
Organization Name:VEIN ESSENTIALS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:EWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-888-8346
Mailing Address - Street 1:3987 E PARADISE FALLS DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6692
Mailing Address - Country:US
Mailing Address - Phone:520-408-6955
Mailing Address - Fax:520-408-9537
Practice Address - Street 1:3987 E PARADISE FALLS DR
Practice Address - Street 2:SUITE 119
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6692
Practice Address - Country:US
Practice Address - Phone:520-408-6955
Practice Address - Fax:520-408-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105847Medicare PIN