Advanced Vein & Laser Center LLC
Organization Active NPI Vascular Surgery Physician · Springboro, OH
NPI 1528088069 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1528088069
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Vascular Surgery Physician 2086S0129X
- Legal business name
- ADVANCED VEIN & LASER CENTER LLC
- Practice address
- 572 N Main St
Springboro, OH 45066-9552 - Phone
- (937) 748-8905
- Fax
- (937) 748-8906
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Gail Markoff, RN
- Title
- Administrator
- Phone
- (937) 748-8905
Practitioners 3
-
Janice Kennedy, FNP-BC
-
Michael W Stogsdill, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091002000421 | OH | Part B Supplier - Clinic/Group Practice | 8820092315 |
Receives reassigned benefits from 3 practitioners Practice locations: Dayton, OH; Springboro, OH |
National Provider Directory
Locations
8101 Millers Farm Ln
Ste 1
Dayton, OH 45458
900 S Dixie Dr
Ste 50
Vandalia, OH 45377
Phone (937) 281-0200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | Yes |
Addresses
Primary practice location
572 N Main St
Springboro, OH 45066-9552
Mailing address
572 N Main St
Springboro, OH 45066-9552
Phone (937) 748-8905
Other providers in Springboro, OH
- Jennifer Jenay Adams
- Katherine E Adams
- Nancy Adomako
- Advanced Joint Kinetics LLC
- Advanced Spine & Pain Management Inc
- Nalini Aggarwal
- Rahaf Al Sayed
- Bonnie L Albertini
- Brittney Allen
- Alliance Physicians Inc
All providers in Springboro, OH · Vascular Surgery Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.