Healthcare Provider Details

I. General information

NPI: 1033578935
Provider Name (Legal Business Name): BACK230 VEIN & BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MAPLE TREE CT SUITE A
GREENVILLE SC
29615-4068
US

IV. Provider business mailing address

308 SCARBOROUGH DR
GREER SC
29650-3664
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7900
  • Fax:
Mailing address:
  • Phone: 864-869-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number33033
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT STEVEN WESTROL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 864-869-8346