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General NPI Number Information
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NPI Number | 1649681842
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Entity Type | Organization
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Legal Business Name | VASCULAR VEIN & IMAGING CENTER
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Dates
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Enumeration Date | 05/11/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 2899 S HOPE DR
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City | YUMA
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State | AZ
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Zip | 85364-7487
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Country | US
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Telephone | 928-276-4293
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Fax | 928-276-4239
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Provider Business Mailing Address
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Address Line | 2281 W 24TH ST STE 1
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City | YUMA
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State | AZ
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Zip | 85364-6154
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Country | US
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Telephone | 928-276-4293
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Fax | 928-276-4239
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. KIRK DOUGLAS MINKUS
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Credential | M.D.
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Telephone | 928-276-4293
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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 | 33081
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License Number State | AZ
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