Provider Demographics
NPI:1790905818
Name:PHLEBOLOGY ASSOCIATES OF LOUISVILLE
Entity Type:Organization
Organization Name:PHLEBOLOGY ASSOCIATES OF LOUISVILLE
Other - Org Name:THE VEIN TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN - PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEESA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-6600
Mailing Address - Street 1:112 SOUTH SHERRIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3222
Mailing Address - Country:US
Mailing Address - Phone:502-895-6600
Mailing Address - Fax:502-899-1229
Practice Address - Street 1:112 SOUTH SHERRIN AVENUE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3222
Practice Address - Country:US
Practice Address - Phone:502-895-6600
Practice Address - Fax:502-899-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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