Healthcare Provider Details

I. General information

NPI: 1609190982
Provider Name (Legal Business Name): SMITH VEIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7536 FREDLE DR
CONCORD TOWNSHIP OH
44077-9406
US

IV. Provider business mailing address

7515 FREDLE DR
PAINESVILLE OH
44077-9406
US

V. Phone/Fax

Practice location:
  • Phone: 440-853-8208
  • Fax: 216-370-3249
Mailing address:
  • Phone: 440-853-8208
  • Fax: 216-370-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number3506461
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35064610
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID G SMITH
Title or Position: OWNER
Credential: M.D.
Phone: 440-853-8208