Healthcare Provider Details

I. General information

NPI: 1154083459
Provider Name (Legal Business Name): MOUNTAIN VEIN CARE PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 FORESIGHT CIR
GRAND JUNCTION CO
81505-1018
US

IV. Provider business mailing address

PO BOX 450
EDWARDS CO
81632-0450
US

V. Phone/Fax

Practice location:
  • Phone: 970-766-8346
  • Fax: 888-979-8915
Mailing address:
  • Phone: 970-766-8346
  • Fax: 888-979-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARL F DANDO
Title or Position: OWNER
Credential: MD
Phone: 970-471-3406