# VEIN CLINIC PA

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

## Provider details

- **NPI number:** 1669534608
- **Authorized official:** CHARLES RUSSELL HEAGLE MD (PRESIDENT OWNER)
- **Authorized official phone:** (952) 934-3296

## Contact information

- **Practice address:** 470 W 78TH ST, STE 250, CHANHASSEN, MN 55317
- **Practice address phone:** (952) 934-3296
- **Practice address fax:** (952) 906-1737
- **Mailing address:** PO BOX 84, WACONIA, MN 55387
- **Mailing address phone:** (952) 934-3296
- **Mailing address fax:** (952) 906-1737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/15/2006
- **Last updated:** 08/22/2020