Healthcare Provider Details

I. General information

NPI: 1730540196
Provider Name (Legal Business Name): VEIN SPECIALTIES AND MEDI-SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BELLEVUE AVE STE 212
SAINT LOUIS MO
63117-1846
US

IV. Provider business mailing address

8 JACCARD LN
SAINT LOUIS MO
63131-2627
US

V. Phone/Fax

Practice location:
  • Phone: 314-287-8080
  • Fax:
Mailing address:
  • Phone: 314-488-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number108988
License Number StateMO

VIII. Authorized Official

Name: MS. MARGARET MARY RIMEL
Title or Position: PRACTICE ADMINISTRATOR
Credential: MBA
Phone: 314-287-8080