# CLEARWATER VEIN CARE CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174693196
- **Authorized official:** ALAN G MUENCH MD (PRESIDENT)
- **Authorized official phone:** (208) 798-7600

## Contact information

- **Practice address:** 3316 1/2 4TH ST, SUITE 4B, LEWISTON, ID 83501-4460
- **Practice address phone:** (208) 798-7600
- **Practice address fax:** (208) 798-7602
- **Mailing address:** 3316 1/2 4TH ST, SUITE 4B, LEWISTON, ID 83501-4460
- **Mailing address phone:** (208) 798-7600
- **Mailing address fax:** (208) 798-7602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | MD00045914 | ID | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 12/16/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001204900 | — | ID |