Provider Demographics
NPI:1235307877
Name:SALT CREEK VEIN TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:SALT CREEK VEIN TREATMENT CENTER LLC
Other - Org Name:HINSDALE VEIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-522-2550
Mailing Address - Street 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-522-2550
Mailing Address - Fax:630-323-0499
Practice Address - Street 1:777 OAKMONT LN
Practice Address - Street 2:SUITE 1200
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5511
Practice Address - Country:US
Practice Address - Phone:630-522-2550
Practice Address - Fax:630-323-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID