CENTER FOR VEIN RESTORATION TN PLLC (NPI# 1215548375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215548375 |
| Entity Type | Organization |
| Organization Name | CENTER FOR VEIN RESTORATION TN PLLC |
| Practice Address |
6005 Park Ave Ste 225b Memphis TN 38119-5207 |
| Mailing Address |
7474 Greenway Center Dr Ste 100 Greenbelt MD 20770-3567 |
| Practice Telephone | 8558308346 |
| Practice Fax Number | 2404734321 |
| Mailing Telephone | 8558308346 |
| Mailing Fax Number | 2404734321 |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2020-08-12 |
| Authorized Official Name | KHANH Q NGUYEN (PRESIDENT) |
| Authorized Official Telephone | 8558308346 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
6005 PARK AVE STE 225B |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38119-5207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417469628 | Jojuan Fullwiley | Behavioral Analyst | 6685 Quince Rd Ste 116, Memphis, TN 38119 | 2017-10-27 |
| 1336675297 | Jill Budynas Depriest | Counselor | 5583 Murray Ave Ste 203, Memphis, TN 38119 | 2017-05-11 |
| 1396279220 | Glen Matthew Stamps Jr. | Counselor | 5583 Murray Ave Ste 207, Memphis, TN 38119 | 2017-04-18 |
| 1598117442 | Hazel Aberdeen | Chiropractor | 1911 Memphis Tennessee, Memphis, TN 38119 | 2016-07-04 |
| 1831569060 | E-c-t Non Emergency Medical Transport | Non-emergency Medical Transport (VAN) | 6869 Woodlake Dr, Memphis, TN 38119 | 2015-09-30 |
| 1053781617 | Astrid Roman | Dietitian, Registered | 8020 Hillside Cv, Memphis, MS 38119 | 2015-09-25 |
| 1467857664 | Allan Jacob Katz | Counselor | 5668 Rex Rd, Suite 104, Memphis, TN 38119 | 2014-10-30 |
| 1962836015 | Judy Ann Harrick | Acupuncturist | 5575 Poplar Ave., #702, Memphis, TN 38119 | 2013-08-26 |
| 1366791949 | Jennifer Denyes Bidelman | Audiologist | 5625 Poplar Avenue, Memphis, TN 38119 | 2012-08-29 |
| 1578833620 | Elizabeth Mary Dion-douglass | Pharmacist | 2891 Kirby Parkway, Memphis, TN 38119 | 2012-01-06 |
| Find all providers in zip 38119 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679969729 | Jeffrey Thomas Johnston | Surgery | 910 Madison Ave Fl 2, Memphis, TN 38103-3403 | 2015-04-15 |
| 1528289808 | Shaun Michael Stickley | Surgery | 1325 Eastmoreland Ave Ste 310, Memphis, TN 38104-7544 | 2007-05-02 |
| 1992813158 | Larry Dale Burke | Surgery | 6025 Walnut Grove Rd Ste 311, Memphis, TN 38120-2123 | 2006-08-28 |
| 1073538823 | Jonathan J Ellichman | Surgery | 6401 Poplar Ave Ste 410, Memphis, TN 38119-4808 | 2006-07-13 |
| 1306112487 | Jorge Luis Weber Guzman | Surgery | 6025 Walnut Grove Rd Ste 301, Memphis, TN 38120-2123 | 2012-03-22 |
| 1881901163 | James Eric Gardner, Md, PC | Surgery | 1750 Madison Ave, Suite 300, Memphis, TN 38104-6492 | 2010-09-08 |
| 1952555666 | Prateek Kumar Gupta | Surgery | 1325 Eastmoreland Ave, Suite 310, Memphis, TN 38104-3519 | 2008-11-07 |
| 1770789349 | Larry Burke, Md, PC | Surgery | 6025 Walnut Grove Rd, #311, Memphis, TN 38120-2131 | 2007-06-21 |
| 1801009089 | James Eric Gardner | Surgery | 1750 Madison Ave, Suite 300, Memphis, TN 38104-6492 | 2007-05-07 |
| 1386744514 | Patricio A. Ilabaca, Md, PC | Surgery | 6027 Walnut Grove Rd, Suite 114, Memphis, TN 38120-2145 | 2006-09-25 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.