Provider Demographics
NPI:1316385404
Name:CENTER FOR VEIN AND VASCULAR DISEASE
Entity Type:Organization
Organization Name:CENTER FOR VEIN AND VASCULAR DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDIBURG
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CAAMA
Authorized Official - Phone:407-767-8554
Mailing Address - Street 1:450 W CENTRAL PKWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2436
Mailing Address - Country:US
Mailing Address - Phone:407-865-7091
Mailing Address - Fax:407-865-7090
Practice Address - Street 1:450 W CENTRAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2436
Practice Address - Country:US
Practice Address - Phone:407-865-7091
Practice Address - Fax:407-865-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD95035207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235150103OtherNPI
1407877384OtherNPI
1437122660OtherNPI
1407877384OtherNPI
1437122660OtherNPI
H74171Medicare UPIN