Provider Demographics
NPI:1457755373
Name:FIRST COAST VEIN, LLC
Entity Type:Organization
Organization Name:FIRST COAST VEIN, LLC
Other - Org Name:PONTE VEDRA VEIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:M
Authorized Official - Last Name:NASIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-280-0600
Mailing Address - Street 1:330 A1A N
Mailing Address - Street 2:SUITE 321
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 A1A N
Practice Address - Street 2:SUITE 321
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1823
Practice Address - Country:US
Practice Address - Phone:904-280-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty