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General NPI Number Information
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NPI Number | 1275350167
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Entity Type | Organization
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Legal Business Name | PREMIER VASCULAR AND VEIN SURGERY CENTER
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1512 COLORADO AVE
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City | TURLOCK
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State | CA
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Zip | 95380-2711
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Country | US
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Telephone | 209-668-8030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4978
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City | MODESTO
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State | CA
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Zip | 95352-4978
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Country | US
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Telephone | 209-575-4575
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | JAMIE DOLE
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Credential |
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Telephone | 209-575-4575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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