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Organization Active NPI

Decatur Vein Clinic, Michigan, PC

Doing business as Decatur Vein Clinic

  • Vascular Surgery Physician
  • Carmel, IN
National Provider Identifier
1093881385
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
DECATUR VEIN CLINIC, MICHIGAN, PC
Doing business as
Decatur Vein Clinic
Practice address
645 W Carmel Dr
Suite 101
Carmel, IN 46032-2605
Phone
(317) 218-2800
Fax
(800) 958-1194
NPI assigned
Nov 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
David R Decatur, MD
Title
Ceo
Phone
(317) 218-2800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

645 W Carmel Dr
Suite 101
Carmel, IN 46032-2605

Mailing address

PO Box 4237
Carmel, IN 46082-4237
Phone (317) 218-2800

Other names 1

  • Decatur Vein Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

645 W Carmel Dr
Ste 101
Carmel, IN 46032
Phone (317) 218-2800

3152 Peregrine Dr NE
Grand Rapids, MI 49525
Phone (317) 218-2813

1669 Hamilton Rd
Ste 220
Okemos, MI 48864
Phone (517) 381-1000

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093881385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4237",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460824237",
            "telephone_number": "317-218-2800",
            "fax_number": "800-958-1194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 W CARMEL DR",
            "address_2": "SUITE 101",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460322605",
            "telephone_number": "317-218-2800",
            "fax_number": "800-958-1194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR VEIN CLINIC, MICHIGAN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECATUR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "317-218-2800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Decatur Vein Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carmel, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.