Healthcare Provider Details

I. General information

NPI: 1194771451
Provider Name (Legal Business Name): CENTER FOR ADVANCED VEIN CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 GRAYSTONE PL
CONOVER NC
28613-8201
US

IV. Provider business mailing address

3513 GRAYSTONE PL
CONOVER NC
28613-8201
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-8485
  • Fax: 828-322-5039
Mailing address:
  • Phone: 828-322-8485
  • Fax: 828-322-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number94-01070
License Number StateNC

VIII. Authorized Official

Name: DR. AARON D THOMPSON
Title or Position: OWNER
Credential: MD
Phone: 828-322-8485