MEDICARE: REEDER VEIN INSTITUTE PA

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	202K00000X	Phlebology Physician	D5822	TX

General Provider Information

NPI Number	:	1942434568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REEDER VEIN INSTITUTE PA

Provider Business Mailing Address
First Line	:	7100 OAKMONT BLVD STE 204
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-3911
Country	:	US
Telephone Number	:	972-566-3040
Fax Number	:	682-499-5921

Provider Business Practice Location Address
First Line	:	7100 OAKMONT BLVD STE 204
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-3911
Country	:	US
Telephone Number	:	972-566-3040
Fax Number	:	682-499-5921

Authorized Official
Title or Position	:	MANAGER
Name	:	JUDY R COCKBURN
Credential	:
Telephone Number	:	575-770-4393

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	10/16/2020

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Directions to “REEDER VEIN INSTITUTE PA ” Practice Location

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