Healthcare Provider Details

I. General information

NPI: 1275181422
Provider Name (Legal Business Name): VIRGINIA VEIN AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20304 TIMBERLAKE RD
LYNCHBURG VA
24502-7222
US

IV. Provider business mailing address

1048 TERRACE DR
MARION VA
24354-4138
US

V. Phone/Fax

Practice location:
  • Phone: 540-798-8477
  • Fax:
Mailing address:
  • Phone: 276-783-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBEKAH ATWELL
Title or Position: CREDENTIALING
Credential:
Phone: 276-783-1827