Healthcare Provider Details

I. General information

NPI: 1588527592
Provider Name (Legal Business Name): PRECISION VEIN & VASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 COOPER DR
IDAHO CITY ID
83631-4148
US

IV. Provider business mailing address

368 E RIVERSIDE DR STE 3A
ST GEORGE UT
84790-7067
US

V. Phone/Fax

Practice location:
  • Phone: 208-982-6734
  • Fax:
Mailing address:
  • Phone: 804-438-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA PIKE
Title or Position: ADMINISTRATOR
Credential: CPC
Phone: 208-982-6734