Provider Demographics
NPI:1427007087
Name:ARTEMIS LASER AND VEIN CENTER
Entity Type:Organization
Organization Name:ARTEMIS LASER AND VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOURBON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-793-8346
Mailing Address - Street 1:6108 PARKCENTER CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3583
Mailing Address - Country:US
Mailing Address - Phone:614-793-8346
Mailing Address - Fax:614-793-8349
Practice Address - Street 1:6108 PARKCENTER CIR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3583
Practice Address - Country:US
Practice Address - Phone:614-793-8346
Practice Address - Fax:614-793-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAR9348341Medicare UPIN