Provider Demographics
NPI:1467769877
Name:PREMIER VEIN SURGERY CENTER
Entity Type:Organization
Organization Name:PREMIER VEIN SURGERY CENTER
Other - Org Name:PREMIER VEIN SURGERY CENTER ADVANCED VEIN AND COSMETIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF SURGERY
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-392-2900
Mailing Address - Street 1:12800 PRESTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-392-2900
Mailing Address - Fax:888-223-2813
Practice Address - Street 1:12800 PRESTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-392-2900
Practice Address - Fax:888-223-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center