Provider Demographics
NPI:1518369537
Name:HENDERSONVILLE AESTHETICS AND VEIN CENTER LLC
Entity Type:Organization
Organization Name:HENDERSONVILLE AESTHETICS AND VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KENNERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-393-4230
Mailing Address - Street 1:420 5TH AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-4202
Mailing Address - Country:US
Mailing Address - Phone:828-393-4230
Mailing Address - Fax:828-393-4000
Practice Address - Street 1:420 5TH AVE W
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4202
Practice Address - Country:US
Practice Address - Phone:828-393-4230
Practice Address - Fax:828-393-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty