Provider Demographics
NPI:1649681842
Name:VASCULAR VEIN & IMAGING CENTER
Entity type:Organization
Organization Name:VASCULAR VEIN & IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MINKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-276-4293
Mailing Address - Street 1:2281 W 24TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6154
Mailing Address - Country:US
Mailing Address - Phone:928-276-4293
Mailing Address - Fax:928-276-4239
Practice Address - Street 1:2899 S HOPE DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7487
Practice Address - Country:US
Practice Address - Phone:928-276-4293
Practice Address - Fax:928-276-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-11
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ330812085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty