MEDICARE: COMPLETE VEIN CARE PLLC

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

General Provider Information

NPI Number	:	1376368878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE VEIN CARE PLLC

Provider Business Mailing Address
First Line	:	140 SW COLUMBIA ST APT 1104
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5885
Country	:	US
Telephone Number	:	314-406-7823
Fax Number	:

Provider Business Practice Location Address
First Line	:	8129 LAKE BALLINGER WAY UNIT 105
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-9182
Country	:	US
Telephone Number	:	312-590-0921
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OF OPERATIONS
Name	:	MR. SCOTT HANSON
Credential	:
Telephone Number	:	314-406-7823

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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Directions to “COMPLETE VEIN CARE PLLC ” Practice Location

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