MEDICARE: TOTAL VEIN SOLUTIONS P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	01058854A	IN

General Provider Information

NPI Number	:	1124553839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL VEIN SOLUTIONS P.C

Provider Business Mailing Address
First Line	:	PO BOX 1289
Second Line	:
City	:	WAIANAE
State	:	HI
Zip	:	96792-1289
Country	:	US
Telephone Number	:	808-341-7567
Fax Number	:	808-356-0424

Provider Business Practice Location Address
First Line	:	3015 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-2347
Country	:	US
Telephone Number	:	808-341-7567
Fax Number	:	808-356-0424

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY BORDERS
Credential	:	MD
Telephone Number	:	808-341-7567

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	05/05/2017

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