Provider Demographics
NPI:1972626547
Name:VEIN CLINIC OF DALLAS LTD
Entity Type:Organization
Organization Name:VEIN CLINIC OF DALLAS LTD
Other - Org Name:VEINTEC VARICOSE VEIN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-696-1264
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 470
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0806
Mailing Address - Country:US
Mailing Address - Phone:214-696-1264
Mailing Address - Fax:214-696-3506
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 470
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-696-1264
Practice Address - Fax:214-696-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty