MEDICARE: CACHE VALLEY VEIN

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
1	2085R0204X	Vascular & Interventional Radiology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1831662311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CACHE VALLEY VEIN

Provider Business Mailing Address
First Line	:	PO BOX 30015
Second Line	:	DEPT 597
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84130-0015
Country	:	US
Telephone Number	:	800-475-6236
Fax Number	:	706-596-6712

Provider Business Practice Location Address
First Line	:	565 W 465 N STE 130
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-4802
Country	:	US
Telephone Number	:	435-753-2842
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN J STROBEL
Credential	:	MD
Telephone Number	:	208-542-5000

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	01/05/2026

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Directions to “CACHE VALLEY VEIN ” Practice Location

Language	Start Address	Practice Location

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