Provider Demographics
NPI:1700925526
Name:ABUNDANT LIFE VEIN CENTER, LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE VEIN CENTER, LLC
Other - Org Name:VEIN CENTERS FOR EXCELLENCE OF DES MOINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-223-0592
Mailing Address - Street 1:1300 37TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1900
Mailing Address - Country:US
Mailing Address - Phone:515-223-0592
Mailing Address - Fax:515-223-8316
Practice Address - Street 1:1300 37TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1900
Practice Address - Country:US
Practice Address - Phone:515-223-0592
Practice Address - Fax:515-223-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAE76857Medicare UPIN