Provider Demographics
NPI:1326558255
Name:VEIN WELLNESS CLINIC, PLLC
Entity Type:Organization
Organization Name:VEIN WELLNESS CLINIC, PLLC
Other - Org Name:ALIQUIPPA VEIN CLINIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:BELAY
Authorized Official - Last Name:BAHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:724-788-1567
Mailing Address - Street 1:600 OLD POND RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1273
Mailing Address - Country:US
Mailing Address - Phone:724-203-0579
Mailing Address - Fax:724-203-4041
Practice Address - Street 1:2020 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001
Practice Address - Country:US
Practice Address - Phone:412-420-9513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201097207R00000X
PAMD436242207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty