Provider Demographics
NPI:1962693457
Name:THE VEIN CENTER, LLP
Entity type:Organization
Organization Name:THE VEIN CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-629-9400
Mailing Address - Street 1:965 WINDHAM CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5088
Mailing Address - Country:US
Mailing Address - Phone:330-629-9400
Mailing Address - Fax:330-629-9441
Practice Address - Street 1:965 WINDHAM CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5088
Practice Address - Country:US
Practice Address - Phone:330-629-9400
Practice Address - Fax:330-629-9441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5300-M2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0526658Medicaid
OHP00225437OtherMDCR RR
OHP00225437OtherMDCR RR
OHC03416Medicare UPIN
OH9352341Medicare PIN