Provider Demographics
NPI:1326640608
Name:UPPERLINE VEIN & VASCULAR PC
Entity Type:Organization
Organization Name:UPPERLINE VEIN & VASCULAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-510-0779
Mailing Address - Street 1:102 WOODMONT BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5202
Mailing Address - Country:US
Mailing Address - Phone:615-627-2205
Mailing Address - Fax:
Practice Address - Street 1:1890 LPGA BLVD STE 255
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7207
Practice Address - Country:US
Practice Address - Phone:386-281-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty