Provider Demographics
NPI:1285841502
Name:DECATUR VEIN CLINIC HOBART, PC
Entity Type:Organization
Organization Name:DECATUR VEIN CLINIC HOBART, PC
Other - Org Name:DECATUR VEIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-218-2807
Mailing Address - Street 1:8925 N MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2386
Mailing Address - Country:US
Mailing Address - Phone:866-218-4060
Mailing Address - Fax:800-591-3117
Practice Address - Street 1:5043 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5912
Practice Address - Country:US
Practice Address - Phone:219-942-1717
Practice Address - Fax:800-591-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251230Medicare PIN