Provider Demographics
NPI:1356181887
Name:PHYSICIANS VEIN CLINICS OF PENNSYLVANIA PLLC
Entity type:Organization
Organization Name:PHYSICIANS VEIN CLINICS OF PENNSYLVANIA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:605-929-9173
Mailing Address - Street 1:3401 S KELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-6300
Mailing Address - Country:US
Mailing Address - Phone:605-274-0217
Mailing Address - Fax:605-277-3858
Practice Address - Street 1:90 GOOD DR STE 301
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4360
Practice Address - Country:US
Practice Address - Phone:888-782-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty