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General NPI Number Information
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NPI Number | 1730540196
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Entity Type | Organization
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Legal Business Name | VEIN SPECIALTIES AND MEDI-SPA, LLC
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 1035 BELLEVUE AVE STE 212
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1846
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Country | US
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Telephone | 314-287-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 8 JACCARD LN
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2627
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Country | US
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Telephone | 314-488-6283
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. MARGARET MARY RIMEL
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Credential | MBA
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Telephone | 314-287-8080
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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 | 108988
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License Number State | MO
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