Organization
CENTER FOR VEIN RESTORATION AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA THOMAS (CREDENTIALING MANAGER)
(815) 254-1761
Entity
Organization
Contact information
Practice address
1500 S DOBSON RD STE 310, MESA, AZ 85202-4751
(855) 830-8346
(240) 473-4321
Mailing address
7474 GREENWAY CENTER DR STE 1000, GREENBELT, MD 20770-3500
(815) 254-1761
(815) 254-5431
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
09/19/2018
Last updated
04/30/2024
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