Organization
MIDWEST VEIN TREATMENT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY MOORE (DIRECTOR OF OPERATIONS)
(512) 342-0455
Entity
Organization
Contact information
Practice address
8101 MILLER FARM LN, SUITE A, CENTERVILLE, OH 45458-7320
(937) 281-0200
(937) 281-0203
Mailing address
8101 MILLER FARM LN, SUITE A, CENTERVILLE, OH 45458-7320
(937) 281-0200
(937) 281-0203
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA5556
RAILROAD MEDICARE GROUP
—
Enumeration date
01/30/2007
Last updated
03/25/2008
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