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General NPI Number Information
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NPI Number | 1386089480
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Entity Type | Organization
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Legal Business Name | OHIO VEIN & VASCULAR INC
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 630 W MAIN ST SUITE 300
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City | WILMINGTON
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State | OH
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Zip | 45177-2170
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Country | US
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Telephone | 865-531-0176
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Fax | 865-531-0722
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Provider Business Mailing Address
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Address Line | 630 W MAIN ST SUITE 300
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City | WILMINGTON
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State | OH
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Zip | 45177-2170
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Country | US
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Telephone | 865-531-0176
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Fax | 865-531-0722
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. BRIAN SANTIN
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Credential | MD
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Telephone | 865-531-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.090093
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35.090093
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License Number State | OH
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