Healthcare Provider Details

I. General information

NPI: 1144536830
Provider Name (Legal Business Name): VEIN CONCEPTS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MCBRIDE AND SON CENTER DR SUITE 201
CHESTERFIELD MO
63005-1418
US

IV. Provider business mailing address

6 MCBRIDE AND SON CENTER DR SUITE 201
CHESTERFIELD MO
63005-1418
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-0241
  • Fax: 636-536-0930
Mailing address:
  • Phone: 636-536-0241
  • Fax: 636-536-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMDR6C15
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberMDR6C15
License Number StateMO

VIII. Authorized Official

Name: BRANDI L JONES
Title or Position: MEDICAL ASSISTANT
Credential:
Phone: 816-590-1808