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General NPI Number Information
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NPI Number | 1417122037
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE VEIN CENTER LLC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 1050 OLD CAMP ROAD STE 202
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City | THE VILLAGES
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State | FL
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Zip | 32162-1762
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Country | US
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Telephone | 352-259-5960
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Fax | 352-750-1854
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Provider Business Mailing Address
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Address Line | 1050 OLD CAMP ROAD STE 202
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City | THE VILLAGES
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State | FL
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Zip | 32162-1762
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Country | US
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Telephone | 352-259-5960
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Fax | 352-750-1854
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Authorized Official
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Title or Position | MANAGING MEMBER, OWNER
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Name | MR. TRI T TRAN
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Credential | PA-C, MPAS
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Telephone | 352-259-5960
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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 | ME96189
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101733
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101724
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS5113
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License Number State | FL
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