Healthcare Provider Details

I. General information

NPI: 1295262160
Provider Name (Legal Business Name): VEIN ABLATION SPECIALISTS AND CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7047 E GREENWAY PKWY STE 250
SCOTTSDALE AZ
85254-8113
US

IV. Provider business mailing address

9590 E IRONWOOD SQUARE DR STE 125
SCOTTSDALE AZ
85258-4583
US

V. Phone/Fax

Practice location:
  • Phone: 386-344-0653
  • Fax:
Mailing address:
  • Phone: 480-455-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAY MHATRE
Title or Position: OWNER
Credential: MD
Phone: 386-344-0653