Advanced Vein Institute of Arizona, LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

17760 Issued in AZ

Legal business name

ADVANCED VEIN INSTITUTE OF ARIZONA, LLC

Practice address

2155 E Conference Dr Ste 101
Tempe, AZ 85284-2604

Phone

(480) 454-5562

Fax

(480) 868-2272

NPI assigned

Dec 16, 2015

Organization subpart

No

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

Authorized official

Name

Jason B Babcock

Title

Administrator

Phone

(480) 454-5562

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1588029672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 E CONFERENCE DR STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852842604",
            "telephone_number": "480-454-5562",
            "fax_number": "480-868-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 E CONFERENCE DR STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852842604",
            "telephone_number": "480-454-5562",
            "fax_number": "480-868-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED VEIN INSTITUTE OF ARIZONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-16",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "BABCOCK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "480-454-5562"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "AZ",
            "license": "17760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104597",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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