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General NPI Number Information
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NPI Number | 1720249972
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Entity Type | Organization
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Legal Business Name | VEIN SPECIALTIES, LLC
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 242 WHIPPLE ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1787
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Country | US
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Telephone | 928-778-0808
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Fax | 928-778-4788
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Provider Business Mailing Address
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Address Line | 242 WHIPPLE ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1787
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Country | US
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Telephone | 928-778-0808
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Fax | 928-778-4788
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Authorized Official
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Title or Position | OWNER
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Name | ROBIN M FLECK
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Credential | MD
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Telephone | 928-778-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 31062
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License Number State | AZ
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