Provider Demographics
NPI:1417122037
Name:COMPREHENSIVE VEIN CENTER LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRI
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MPAS
Authorized Official - Phone:352-259-5960
Mailing Address - Street 1:1050 OLD CAMP ROAD
Mailing Address - Street 2:STE 202
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1762
Mailing Address - Country:US
Mailing Address - Phone:352-259-5960
Mailing Address - Fax:352-750-1854
Practice Address - Street 1:1050 OLD CAMP ROAD
Practice Address - Street 2:STE 202
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-259-5960
Practice Address - Fax:352-750-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96189202K00000X
FLOS5113207Q00000X
FLPA9101733363A00000X
FLPA9101724363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty