Provider Demographics
NPI:1942434568
Name:REEDER VEIN INSTITUTE PA
Entity Type:Organization
Organization Name:REEDER VEIN INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COCKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-770-4393
Mailing Address - Street 1:7100 OAKMONT BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3911
Mailing Address - Country:US
Mailing Address - Phone:972-566-3040
Mailing Address - Fax:682-499-5921
Practice Address - Street 1:7100 OAKMONT BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3911
Practice Address - Country:US
Practice Address - Phone:972-566-3040
Practice Address - Fax:682-499-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5822202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty