Healthcare Provider Details

I. General information

NPI: 1356181887
Provider Name (Legal Business Name): PHYSICIANS VEIN CLINICS OF PENNSYLVANIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 GOOD DR STE 301
LANCASTER PA
17603-4360
US

IV. Provider business mailing address

3401 S KELLEY AVE
SIOUX FALLS SD
57106-6300
US

V. Phone/Fax

Practice location:
  • Phone: 888-782-8346
  • Fax:
Mailing address:
  • Phone: 605-274-0217
  • Fax: 605-277-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: LORNELL HANSEN II
Title or Position: OWNER
Credential: MD
Phone: 605-929-9173