Healthcare Provider Details

I. General information

NPI: 1609059963
Provider Name (Legal Business Name): BIG COUNTRY VEIN RELIEF, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 S 14TH ST
ABILENE TX
79605-4733
US

IV. Provider business mailing address

4716 S 14TH ST
ABILENE TX
79605-4733
US

V. Phone/Fax

Practice location:
  • Phone: 325-795-1200
  • Fax: 315-792-1202
Mailing address:
  • Phone: 325-795-1200
  • Fax: 325-795-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberE6443
License Number StateTX

VIII. Authorized Official

Name: DR. BILLY DON JONES
Title or Position: PARTNER
Credential: MD
Phone: 325-795-1200