Provider Demographics
NPI:1790875565
Name:VEIN CLINIC OF THE PALM BEACHES LLC
Entity Type:Organization
Organization Name:VEIN CLINIC OF THE PALM BEACHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-507-2283
Mailing Address - Street 1:115 NE 3RD ST
Mailing Address - Street 2:SUITE B&C
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2901
Mailing Address - Country:US
Mailing Address - Phone:863-357-0888
Mailing Address - Fax:863-357-1330
Practice Address - Street 1:115 NE 3RD ST
Practice Address - Street 2:SUITE B&C
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2901
Practice Address - Country:US
Practice Address - Phone:863-357-0888
Practice Address - Fax:863-357-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA941ZMedicare PIN
I17125Medicare UPIN