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General NPI Number Information
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NPI Number | 1124206073
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Entity Type | Organization
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Legal Business Name | BIG COUNTRY VEIN RELIEF LP
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Dates
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Enumeration Date | 02/02/2008
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Last Update Date | 02/02/2008
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Provider Practice Location Address
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Address Line | 109 S PARK DR
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City | BROWNWOOD
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State | TX
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Zip | 76801-5917
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Country | US
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Telephone | 325-643-3300
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Fax | 325-641-8714
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Provider Business Mailing Address
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Address Line | 4716 S 14TH ST
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City | ABILENE
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State | TX
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Zip | 79605-4733
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Country | US
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Telephone | 325-795-1200
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Fax |
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Authorized Official
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Title or Position | BOM
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Name | ARLENE N GAULDEN
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Credential |
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Telephone | 325-647-4397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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