Provider Demographics
NPI:1639414618
Name:GULF COAST VEIN CENTER, P.A.
Entity Type:Organization
Organization Name:GULF COAST VEIN CENTER, P.A.
Other - Org Name:BOWERS VEIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-623-9999
Mailing Address - Street 1:4900 95TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-3544
Mailing Address - Country:US
Mailing Address - Phone:727-623-9999
Mailing Address - Fax:
Practice Address - Street 1:4900 95TH AVE N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-3544
Practice Address - Country:US
Practice Address - Phone:727-623-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007951800Medicaid
FL007951800Medicaid