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General NPI Number Information
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NPI Number | 1720370133
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Entity Type | Organization
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Legal Business Name | PHYSICIANS VEIN CLINICS, PC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 3401 S KELLEY AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-6300
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Country | US
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Telephone | 605-274-0217
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Fax | 605-275-6398
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Provider Business Mailing Address
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Address Line | 3401 S KELLEY AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57106-6300
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Country | US
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Telephone | 605-274-0217
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Fax | 605-275-6398
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LORNELL EUGENE HANSEN II
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Credential | MD
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Telephone | 605-275-6128
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4768
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License Number State | SD
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