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NPI Code Detail

MEDICARE: VEIN ABLATION SPECIALISTS AND CONSULTANTS LLC

MEDICARE: VEIN ABLATION SPECIALISTS AND CONSULTANTS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0204XVascular & Interventional Radiology Physician
2207RC0000XCardiovascular Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295262160
Entity Type Code : Organization
Provider Name (Legal Business Name) : VEIN ABLATION SPECIALISTS AND CONSULTANTS LLC
Provider Business Mailing Address
First Line : 9590 E IRONWOOD SQUARE DR STE 125
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85258-4583
Country : US
Telephone Number : 480-455-3000
Fax Number :
Provider Business Practice Location Address
First Line : 7047 E GREENWAY PKWY STE 250
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85254-8113
Country : US
Telephone Number : 386-344-0653
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AJAY MHATRE
Credential : MD
Telephone Number : 386-344-0653
Provider Enumeration Date : 05/22/2017
Last Update Date : 07/21/2022

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