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General NPI Number Information
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NPI Number | 1588029672
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Entity Type | Organization
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Legal Business Name | ADVANCED VEIN INSTITUTE OF ARIZONA, LLC
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 2155 E CONFERENCE DR STE 101
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City | TEMPE
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State | AZ
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Zip | 85284-2604
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Country | US
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Telephone | 480-454-5562
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Fax | 480-868-2272
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Provider Business Mailing Address
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Address Line | 2155 E CONFERENCE DR STE 101
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City | TEMPE
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State | AZ
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Zip | 85284-2604
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Country | US
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Telephone | 480-454-5562
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Fax | 480-868-2272
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JASON B BABCOCK
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Credential |
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Telephone | 480-454-5562
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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 | 17760
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License Number State | AZ
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