Organization
PREMIER VEIN CARE
Active
Other names
PREMIER VEIN CARE
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH STEVENS M.D. (PRESIDENT)
(815) 378-8514
Entity
Organization
Contact information
Practice address
3268 WATERSTONE AVE, HENDERSON, NV 89044-1867
(815) 378-8514
Mailing address
3268 WATERSTONE AVE, HENDERSON, NV 89044-1867
(815) 378-8514
(805) 540-3344
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64552Y
BLUE SHIELD PROVIDER NUMBER
CA
Enumeration date
07/21/2010
Last updated
05/05/2025
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