Provider Demographics
NPI:1306203120
Name:VEIN CLINIC SAINT JOSEPH LLC
Entity Type:Organization
Organization Name:VEIN CLINIC SAINT JOSEPH LLC
Other - Org Name:ALSARA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-425-7272
Mailing Address - Street 1:PO BOX 8694
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8694
Mailing Address - Country:US
Mailing Address - Phone:816-396-0245
Mailing Address - Fax:816-558-6544
Practice Address - Street 1:1105 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2532
Practice Address - Country:US
Practice Address - Phone:844-425-7272
Practice Address - Fax:816-558-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005006001261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty