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General NPI Number Information
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NPI Number | 1013885110
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Entity Type | Organization
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Legal Business Name | CENTER FOR VEIN RESTORATION IN, LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 141 QUARTERMASTER CT
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3627
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Country | US
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Telephone | 855-830-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 7474 GREENWAY CENTER DR STE 1000
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City | GREENBELT
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State | MD
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Zip | 20770-3500
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Country | US
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Telephone | 855-830-8346
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Fax |
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Authorized Official
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Title or Position | CRED MANAGER
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Name | LORENA THOMAS
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Credential |
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Telephone | 815-254-1761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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