Provider Demographics
NPI:1710938659
Name:REGIONAL VASCULAR & VEIN
Entity type:Organization
Organization Name:REGIONAL VASCULAR & VEIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-760-2295
Mailing Address - Street 1:6046 WHIPPLE AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7616
Mailing Address - Country:US
Mailing Address - Phone:234-347-0450
Mailing Address - Fax:
Practice Address - Street 1:6046 WHIPPLE AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7616
Practice Address - Country:US
Practice Address - Phone:234-347-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL SURGICAL SPECIALISTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071936208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2267676Medicaid
OH2300709Medicaid
OHID01191OtherCANTON LAB
OH2187360Medicaid
OHCG7848OtherRR MEDICARE DOVER
OHCK3919OtherRR MEDICARE CANTON
OH9301653Medicare PIN
OHCG7848OtherRR MEDICARE DOVER