Longevity Vein Clinic LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LONGEVITY VEIN CLINIC LLC

Practice address

15421 Clayton Rd Ste G1
Ballwin, MO 63011-3161

Phone

(314) 639-9475

NPI assigned

May 23, 2025

Last updated

May 23, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ameen M Bajwa

Title

Cfo

Phone

(314) 954-4005

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mohammed Zahid Siddiqui, MD

  • Medical Oncology Physician
  • Nashville, IL
  • NPI 1730115973

  MO

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1033902994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15421 CLAYTON RD STE G1",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113161",
            "telephone_number": "314-639-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15421 CLAYTON RD STE G1",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113161",
            "telephone_number": "314-639-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY VEIN CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-23",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A",
        "authorized_official_last_name": "BAJWA",
        "authorized_official_first_name": "AMEEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-954-4005"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Cittadino Link, DDS
• Live Well Be Well LLC
• Erica Lockhart
• Stephanie Loesch, LPC
• Katelyn Theresa Long
• Alexandria A Lovelace
• Victoria Loving
• Thomas J. Lovinguth, PH.D.
• Cynthia Jean Lucas, O.D.
• Steve Lucido, PHARM.D.

• Internal Medicine Physician in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.