Provider Demographics
NPI:1326679952
Name:ADVANCED VEIN AND VASCULAR OF SOUTHERN UTAH LLC
Entity Type:Organization
Organization Name:ADVANCED VEIN AND VASCULAR OF SOUTHERN UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-425-4200
Mailing Address - Street 1:273 N 2975 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8835
Mailing Address - Country:US
Mailing Address - Phone:801-425-4200
Mailing Address - Fax:
Practice Address - Street 1:1251 NORTHFIELD RD # 103
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8622
Practice Address - Country:US
Practice Address - Phone:435-383-5770
Practice Address - Fax:435-383-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-02
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty