Organization
LIVING WATER VEIN INSTITUTE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN F BERRY MD (MEDICAL DIRECTOR)
(423) 631-0101
Entity
Organization
Contact information
Practice address
2800 PEOPLES ST STE 80, JOHNSON CITY, TN 37604-4158
(423) 631-0101
(423) 328-9027
Mailing address
2800 PEOPLES ST STE 80, JOHNSON CITY, TN 37604-4158
(423) 631-0101
(423) 328-9027
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10704871
CAQH
—
Enumeration date
04/16/2019
Last updated
08/19/2019
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