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General NPI Number Information
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NPI Number | 1104994219
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Entity Type | Organization
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Legal Business Name | VEIN CARE OF OHIO-WEST, LLC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4330 W 150TH ST SUITE 103
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City | CLEVELAND
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State | OH
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Zip | 44135-1362
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Country | US
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Telephone | 216-688-8000
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Fax | 216-688-0075
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Provider Business Mailing Address
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Address Line | 4330 W 150TH ST SUITE 103
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City | CLEVELAND
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State | OH
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Zip | 44135-1362
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Country | US
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Telephone | 216-688-8000
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Fax | 216-688-0075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRADLEY A BLACKBURN
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Credential | M.D.
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Telephone | 216-688-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 35053437
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35053437
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License Number State | OH
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