Provider Demographics
NPI:1194771451
Name:CENTER FOR ADVANCED VEIN CARE PLLC
Entity type:Organization
Organization Name:CENTER FOR ADVANCED VEIN CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-322-8485
Mailing Address - Street 1:3513 GRAYSTONE PL
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8201
Mailing Address - Country:US
Mailing Address - Phone:828-322-8485
Mailing Address - Fax:828-322-5039
Practice Address - Street 1:3513 GRAYSTONE PL
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-322-8485
Practice Address - Fax:828-322-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-01070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891341UMedicaid
NCF57987Medicare UPIN
NC891341UMedicaid