Provider Demographics
NPI:1437401106
Name:PALM VEIN CENTER LLC
Entity Type:Organization
Organization Name:PALM VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DRAGON
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:623-201-4777
Mailing Address - Street 1:16944 W BELL RD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8950
Mailing Address - Country:US
Mailing Address - Phone:623-201-4777
Mailing Address - Fax:623-201-4770
Practice Address - Street 1:16944 W BELL RD
Practice Address - Street 2:#603
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8950
Practice Address - Country:US
Practice Address - Phone:623-201-4777
Practice Address - Fax:623-201-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center