Basic Information
| Provider Information | |||||||||
| NPI: | 1629316971 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VINCENT VEIN CENTER DENVER,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7600 PARK MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | LONETREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801242560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037995199 | ||||||||
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| Address1: | 7600 PARK MEADOWS DR | ||||||||
| Address2: | |||||||||
| City: | LONETREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801242560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037995199 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | JOHNS | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 9702541686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.