Provider Demographics
NPI:1720269558
Name:UTAH VEIN SPECIALISTS, INC.
Entity type:Organization
Organization Name:UTAH VEIN SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-501-8306
Mailing Address - Street 1:7410 S CREEK RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6151
Mailing Address - Country:US
Mailing Address - Phone:801-501-8346
Mailing Address - Fax:801-501-2627
Practice Address - Street 1:7410 S CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6151
Practice Address - Country:US
Practice Address - Phone:801-501-8346
Practice Address - Fax:801-501-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1885981205202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty