Provider Demographics
NPI:1891278990
Name:RESTORE VEIN AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RESTORE VEIN AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-208-9001
Mailing Address - Street 1:2010 PATTON CHAPEL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5783
Mailing Address - Country:US
Mailing Address - Phone:205-208-9001
Mailing Address - Fax:205-208-0031
Practice Address - Street 1:2010 PATTON CHAPEL RD STE 102
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-5783
Practice Address - Country:US
Practice Address - Phone:205-208-9001
Practice Address - Fax:205-208-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty