Provider Demographics
NPI:1922655687
Name:COATES VEIN CLINIC, PLLC
Entity Type:Organization
Organization Name:COATES VEIN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIFFIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-849-8346
Mailing Address - Street 1:15920 S RANCHO SAHUARITA BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8014
Mailing Address - Country:US
Mailing Address - Phone:520-849-8346
Mailing Address - Fax:888-849-8354
Practice Address - Street 1:15920 S RANCHO SAHUARITA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8014
Practice Address - Country:US
Practice Address - Phone:520-849-8346
Practice Address - Fax:888-849-8354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. GRIFFIN COATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty