Provider Demographics
NPI:1376368878
Name:COMPLETE VEIN CARE PLLC
Entity type:Organization
Organization Name:COMPLETE VEIN CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-406-7823
Mailing Address - Street 1:140 SW COLUMBIA ST APT 1104
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5885
Mailing Address - Country:US
Mailing Address - Phone:314-406-7823
Mailing Address - Fax:
Practice Address - Street 1:8129 LAKE BALLINGER WAY UNIT 105
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9182
Practice Address - Country:US
Practice Address - Phone:312-590-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty