Vein Clinic of Lake Havasu

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

VEIN CLINIC OF LAKE HAVASU

Practice address

2156 Rudolph Dr
Lake Havasu City, AZ 86406-8106

Phone

(928) 453-1800

NPI assigned

Aug 12, 2016

Last updated

Oct 19, 2016By 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

Bobby A Shah, MD

Title

Owner

Phone

(928) 453-1800

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1470960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1285188763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2156 RUDOLPH DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864068106",
            "telephone_number": "928-453-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2156 RUDOLPH DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864068106",
            "telephone_number": "928-453-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VEIN CLINIC OF LAKE HAVASU",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-12",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-453-1800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John C Twomey, P.T.
• Sandra Louise Ulmer, DNP, FNP-BC
• Arikka Nikole Utz, OTA
• Kenneth Van Wyk
• Lindsay Vanlaningham
• Angela Veneroni, PT
• Veritas Healthcare PLLC
• Tamara Vestal, RN153164
• Brooke Louise Vetter, O.D.
• Casandra Villafana, LMT

• Radiology Clinic/Center in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Radiology Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.