Provider Demographics
NPI:1467792457
Name:VEIN CARE ASSOCIATES S.C.
Entity Type:Organization
Organization Name:VEIN CARE ASSOCIATES S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-955-8346
Mailing Address - Street 1:2801 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2125
Mailing Address - Country:US
Mailing Address - Phone:800-955-8346
Mailing Address - Fax:952-934-5728
Practice Address - Street 1:215 CORPORATE DRIVE
Practice Address - Street 2:SUITE H
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3124
Practice Address - Country:US
Practice Address - Phone:920-887-7731
Practice Address - Fax:888-389-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
WI56238-020261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99064Medicare UPIN