Provider Demographics
NPI:1952641995
Name:VINCENT VEIN CENTER GRAND JUNCTION PC
Entity Type:Organization
Organization Name:VINCENT VEIN CENTER GRAND JUNCTION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-263-7348
Mailing Address - Street 1:601 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2041
Mailing Address - Country:US
Mailing Address - Phone:970-263-7348
Mailing Address - Fax:970-241-1674
Practice Address - Street 1:601 CENTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2041
Practice Address - Country:US
Practice Address - Phone:970-263-7348
Practice Address - Fax:970-241-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty