Provider Demographics
NPI:1326076902
Name:VEIN ASSOCIATES, PA
Entity Type:Organization
Organization Name:VEIN ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THEOBALD
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:803-808-8070
Mailing Address - Street 1:PO BOX 863550
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3550
Mailing Address - Country:US
Mailing Address - Phone:803-808-8070
Mailing Address - Fax:803-808-8074
Practice Address - Street 1:400 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5061
Practice Address - Country:US
Practice Address - Phone:803-808-8070
Practice Address - Fax:803-808-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97985OtherBCBS GROUP NUMBER
MN53M96REOtherBCBS GROUP NUMBER
SC=========001OtherBCBS GROUP NUMBER
SC=========001OtherBCBS GROUP NUMBER
FL97985OtherBCBS GROUP NUMBER
MNC03977Medicare ID - Type UnspecifiedGROUP NUMBER