Provider Demographics
NPI:1912276999
Name:DECATUR VEIN CLINIC COLORADO, PC
Entity Type:Organization
Organization Name:DECATUR VEIN CLINIC COLORADO, PC
Other - Org Name:COLORADO VEIN CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-263-7348
Mailing Address - Street 1:7600 PARK MEADOWS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2560
Mailing Address - Country:US
Mailing Address - Phone:303-799-5199
Mailing Address - Fax:303-799-6634
Practice Address - Street 1:7600 PARK MEADOWS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2560
Practice Address - Country:US
Practice Address - Phone:303-799-5199
Practice Address - Fax:303-799-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty