Provider Demographics
NPI:1609346303
Name:SUPERIOR VEIN CARE, PLLP
Entity Type:Organization
Organization Name:SUPERIOR VEIN CARE, PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AZUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHLMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-600-1550
Mailing Address - Street 1:3875 E OVERLAND RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9005
Mailing Address - Country:US
Mailing Address - Phone:208-484-2431
Mailing Address - Fax:866-335-0887
Practice Address - Street 1:3277 E LOUISE DR STE 360
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9359
Practice Address - Country:US
Practice Address - Phone:208-600-1550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center