NPIMap

Organization Active NPI

Vascular and Vein Institute of the South, PLLC

  • Foot & Ankle Surgery Podiatrist
  • Memphis, TN
National Provider Identifier
1073396453
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
VASCULAR AND VEIN INSTITUTE OF THE SOUTH, PLLC
Practice address
1653 Poplar Ave
Memphis, TN 38104-2511
Phone
(901) 390-2930
NPI assigned
Aug 17, 2023
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
VASCULAR AND VEIN INSTITUTE OF THE SOUTH PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Deona Deicke
Title
Credentialing Specialist
Phone
(203) 641-9529

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X
Vascular Surgery Physician 2086S0129X
Podiatrist 213E00000X
Foot & Ankle Surgery Podiatrist 213ES0103X Primary

Addresses

Primary practice location

1653 Poplar Ave
Memphis, TN 38104-2511

Mailing address

PO Box 386
Boynton Beach, FL 33425-0386
Phone (203) 641-9529

National Provider Directory

National Provider Directory
Tax ID family
Vas and Vein Inst of the S4 organizations share this tax ID, including this one
Part of
Vas and Vein Inst of the S

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

306 S Rhodes St
West Memphis, AR 72301

705 N State St
Clarksdale, MS 38614
Phone (662) 621-2192

2980 Poplar Ave
Ste 101
Memphis, TN 38111
Phone (610) 314-1967

877 Jefferson Ave
#One
Memphis, TN 38103
Phone (800) 351-3434

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1073396453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 386",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334250386",
            "telephone_number": "203-641-9529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042511",
            "telephone_number": "901-390-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR AND VEIN INSTITUTE OF THE SOUTH, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VASCULAR AND VEIN INSTITUTE OF THE SOUTH PLLC",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "DEICKE",
        "authorized_official_first_name": "DEONA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "203-641-9529"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.