Provider Demographics
NPI:1225528565
Name:VEIN ENVY LLC
Entity Type:Organization
Organization Name:VEIN ENVY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/CODER/CREDENTIALING SPEC
Authorized Official - Prefix:
Authorized Official - First Name:AMETHYST
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFLEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-233-1050
Mailing Address - Street 1:14044 W CAMELBACK RD STE 226
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9426
Mailing Address - Country:US
Mailing Address - Phone:623-233-1050
Mailing Address - Fax:623-248-6952
Practice Address - Street 1:14044 W CAMELBACK RD STE 226
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9426
Practice Address - Country:US
Practice Address - Phone:623-233-1050
Practice Address - Fax:623-248-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2086S0129X
AZ006421261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ615010283Medicaid
AZ47-4987836Medicaid