Provider Demographics
NPI:1477837037
Name:INDIANA VEIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:INDIANA VEIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHOONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-348-3023
Mailing Address - Street 1:11876 OLIO RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9765
Mailing Address - Country:US
Mailing Address - Phone:317-844-4210
Mailing Address - Fax:317-844-4206
Practice Address - Street 1:11876 OLIO RD
Practice Address - Street 2:SUITE 700
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9765
Practice Address - Country:US
Practice Address - Phone:317-844-4210
Practice Address - Fax:317-844-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060951A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty