Provider Demographics
NPI:1376415133
Name:AVANCE VEIN CARE LLC
Entity type:Organization
Organization Name:AVANCE VEIN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VEIN SPECIALIST/ CMO
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:TADEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-849-8450
Mailing Address - Street 1:21 SEDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-3032
Mailing Address - Country:US
Mailing Address - Phone:417-849-8450
Mailing Address - Fax:
Practice Address - Street 1:1 WILSON DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-4416
Practice Address - Country:US
Practice Address - Phone:417-849-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty