Provider Demographics
NPI:1306051081
Name:VANISHING VEINS OF IDAHO
Entity type:Organization
Organization Name:VANISHING VEINS OF IDAHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-292-1411
Mailing Address - Street 1:1859 N LAKEWOOD DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2661
Mailing Address - Country:US
Mailing Address - Phone:208-292-1411
Mailing Address - Fax:208-292-0262
Practice Address - Street 1:1859 N LAKEWOOD DR
Practice Address - Street 2:SUITE 303
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2661
Practice Address - Country:US
Practice Address - Phone:208-292-1411
Practice Address - Fax:208-292-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty