Provider Demographics
NPI:1902122161
Name:NELSON VEIN AND SURGICAL SERVICES LLC
Entity Type:Organization
Organization Name:NELSON VEIN AND SURGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DVORA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-315-7830
Mailing Address - Street 1:30915 LORAIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4722
Mailing Address - Country:US
Mailing Address - Phone:440-617-6061
Mailing Address - Fax:440-617-6065
Practice Address - Street 1:30915 LORAIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4722
Practice Address - Country:US
Practice Address - Phone:440-617-6061
Practice Address - Fax:440-617-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty