| Vestra Labs LLC | |
|
11036 N 23rd Ave Ste 8 Phoenix AZ 85029-4800 | |
| (623) 334-1390 | |
| Not Available |
| Full Name | Vestra Labs LLC |
|---|---|
| Speciality | Phlebology |
| Location | 11036 N 23rd Ave Ste 8, Phoenix, Arizona |
| Authorized Official Name and Position | Matthew Nagelbush (CEO) |
| Authorized Official Contact | 6232053445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vestra Labs LLC 11036 N 23rd Ave Ste 8 Phoenix AZ 85029-4800 Ph: (623) 334-1390 | Vestra Labs LLC 11036 N 23rd Ave Ste 8 Phoenix AZ 85029-4800 Ph: (623) 334-1390 |
| NPI Number | 1518546548 |
|---|---|
| Provider Enumeration Date | 04/06/2021 |
| Last Update Date | 04/06/2021 |
| Certification Date | 04/06/2021 |
| Medicare PECOS PAC ID | 7810306222 |
|---|---|
| Medicare Enrollment ID | O20210513003021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518546548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (NU) | Secondary |
| 261QP0904X | Clinic/center - Public Health, Federal | (NU) | Secondary |
| 202K00000X | Phlebology | (NU) | Primary |
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