NPIMap

Organization Active NPI

Vein Care Pavilion of the South

  • Surgery Physician
  • Germantown, WI
National Provider Identifier
1144569757
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
44670-20 Issued in WI
Legal business name
VEIN CARE PAVILION OF THE SOUTH
Practice address
W178N9912 Rivercrest Dr
Suite 102
Germantown, WI 53022-4645
Phone
(262) 672-6900
NPI assigned
Feb 4, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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

Authorized official

Name
Lori Davis
Title
Managing Member
Phone
(706) 951-1998

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 44670-20 WI Primary

Addresses

Primary practice location

W178N9912 Rivercrest Dr
Suite 102
Germantown, WI 53022-4645

Mailing address

W178N9912 Rivercrest Dr
Suite 102
Germantown, WI 53022-4645
Phone (262) 672-6900

National Provider Directory

National Provider Directory

Locations

W177N9886 Rivercrest Dr
Ste 107
Germantown, WI 53022
Phone (262) 672-6900

W178N9912 Rivercrest Dr
#10
Germantown, WI 53022
Phone (262) 672-6900

NPI Registry JSON

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

{
    "created_epoch": "1359936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1144569757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W178N9912 RIVERCREST DR",
            "address_2": "SUITE 102",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530224645",
            "telephone_number": "262-672-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W178N9912 RIVERCREST DR",
            "address_2": "SUITE 102",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530224645",
            "telephone_number": "262-672-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VEIN CARE PAVILION OF THE SOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-04",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "706-951-1998"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WI",
            "license": "44670-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.