Provider Demographics
NPI:1245306547
Name:THE VEIN CENTER
Entity type:Organization
Organization Name:THE VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-287-2888
Mailing Address - Street 1:401 ALCORN DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9072
Mailing Address - Country:US
Mailing Address - Phone:662-287-2888
Mailing Address - Fax:662-287-2925
Practice Address - Street 1:401 ALCORN DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9072
Practice Address - Country:US
Practice Address - Phone:662-287-2888
Practice Address - Fax:662-287-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherTRICARE
MS=========OtherTRICARE
MSDD4726Medicare ID - Type UnspecifiedRAILROAD