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NPI Code Detail

MEDICARE: THE VEIN INSTITUTE, PC

MEDICARE: THE VEIN INSTITUTE, PC
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
1208600000XSurgery Physician
2202K00000XPhlebology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103G700982OTHERTNMEDICARE PTAN

General Provider Information

NPI Number : 1437524683
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE VEIN INSTITUTE, PC
Provider Business Mailing Address
First Line : 1405 COWART ST
Second Line : STE 321
City : CHATTANOOGA
State : TN
Zip : 37408-1127
Country : US
Telephone Number : 423-551-8346
Fax Number : 423-551-8347
Provider Business Practice Location Address
First Line : 1405 COWART ST
Second Line : STE 321
City : CHATTANOOGA
State : TN
Zip : 37408-1127
Country : US
Telephone Number : 423-551-8346
Fax Number : 423-551-8347
Authorized Official
Title or Position : OWNER
Name : VINCENT WAYNE GARDNER
Credential : MD
Telephone Number : 423-551-8346
Provider Enumeration Date : 12/14/2015
Last Update Date : 04/14/2016

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1629077011 — DR. GORDON D GRAHAM MD
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1447259742 — DR. VAN STEPHEN MONROE JR. MD
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1689673998 — DR. BRIAN H NEGUS MD
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Directions to “THE VEIN INSTITUTE, PC ” Practice Location

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