| Superior Vein Care, Pllp | |
|
3277 E Louise Dr Ste 360 Meridian ID 83642-9359 | |
| (208) 600-1550 | |
| (208) 600-1551 |
| Full Name | Superior Vein Care, Pllp |
|---|---|
| Speciality | Surgery |
| Location | 3277 E Louise Dr Ste 360, Meridian, Idaho |
| Authorized Official Name and Position | Azul Cohlmia (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 2086001550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Superior Vein Care, Pllp 3875 E Overland Rd Ste 2d Meridian ID 83642-9005 Ph: (208) 484-2431 | Superior Vein Care, Pllp 3277 E Louise Dr Ste 360 Meridian ID 83642-9359 Ph: (208) 600-1550 |
| NPI Number | 1609346303 |
|---|---|
| Provider Enumeration Date | 11/26/2018 |
| Last Update Date | 05/14/2024 |
| Medicare PECOS PAC ID | 0244577393 |
|---|---|
| Medicare Enrollment ID | O20190128000928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609346303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | (* (Not Available)) | Primary |
| Provider Name | Michael J Tullis |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1598717985 PECOS PAC ID: 0840223855 Enrollment ID: I20050912000260 |
| Provider Name | Mark Paul Macumber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598805830 PECOS PAC ID: 1456257492 Enrollment ID: I20221208001227 |
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