Provider Demographics
NPI:1205347127
Name:VEIN INSTITUTE OF PINELLAS LLC
Entity type:Organization
Organization Name:VEIN INSTITUTE OF PINELLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:POULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-820-1040
Mailing Address - Street 1:1839 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8900
Mailing Address - Country:US
Mailing Address - Phone:727-820-1040
Mailing Address - Fax:727-821-7213
Practice Address - Street 1:5500 9TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1204
Practice Address - Country:US
Practice Address - Phone:727-525-5500
Practice Address - Fax:727-522-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty