Healthcare Provider Details

I. General information

NPI: 1982659306
Provider Name (Legal Business Name): VARICOSE VEIN CENTERS OF GREATER CINCINNATI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7794 5 MILE RD STE 270
CINCINNATI OH
45230-2368
US

IV. Provider business mailing address

PO BOX 634984
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-7900
  • Fax: 513-624-0401
Mailing address:
  • Phone: 513-891-2813
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH C RUSSELL
Title or Position: PRESIDENT/ CEO
Credential: MD
Phone: 513-624-7900