Healthcare Provider Details

I. General information

NPI: 1538696471
Provider Name (Legal Business Name): MEDICAL VEIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ISOM RD
SAN ANTONIO TX
78216-4464
US

IV. Provider business mailing address

622 ISOM RD
SAN ANTONIO TX
78216-4464
US

V. Phone/Fax

Practice location:
  • Phone: 210-622-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN S HOGG
Title or Position: PRESIDENT
Credential: MD
Phone: 512-289-2198