# VASCULAR AND VEIN INSTITUTE OF THE SOUTH, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VASCULAR AND VEIN INSTITUTE OF THE SOUTH PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073396453
- **Legal business name:** VASCULAR AND VEIN INSTITUTE OF THE SOUTH PLLC
- **Authorized official:** DEONA DEICKE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (203) 641-9529

## Contact information

- **Practice address:** 1653 POPLAR AVE, MEMPHIS, TN 38104-2511
- **Practice address phone:** (901) 390-2930
- **Mailing address:** PO BOX 386, BOYNTON BEACH, FL 33425-0386
- **Mailing address phone:** (203) 641-9529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 08/17/2023
- **Last updated:** 08/17/2023