Healthcare Provider Details

I. General information

NPI: 1881901189
Provider Name (Legal Business Name): BAILEY VEIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64-1035 MAMALAHOA HWY SUITE K
KAMUELA HI
96743-8440
US

IV. Provider business mailing address

1075 NICHOLS RD SUITE 5
OSAGE BEACH MO
65065-3093
US

V. Phone/Fax

Practice location:
  • Phone: 808-885-4401
  • Fax: 808-885-4412
Mailing address:
  • Phone: 573-302-0032
  • Fax: 573-302-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number15676
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number15676
License Number StateHI

VIII. Authorized Official

Name: DR. COLIN E BAILEY
Title or Position: OWNER
Credential: M.D.
Phone: 573-302-0032