Provider Demographics
NPI:1528088069
Name:ADVANCED VEIN & LASER CENTER LLC
Entity type:Organization
Organization Name:ADVANCED VEIN & LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:937-748-8905
Mailing Address - Street 1:572 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9552
Mailing Address - Country:US
Mailing Address - Phone:937-748-8905
Mailing Address - Fax:937-748-8906
Practice Address - Street 1:572 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9552
Practice Address - Country:US
Practice Address - Phone:937-748-8905
Practice Address - Fax:937-748-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty