Provider Demographics
NPI:1487977138
Name:INTEGRAL VEIN INSTITUTE LLC
Entity type:Organization
Organization Name:INTEGRAL VEIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:BOSTICK
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:419-425-5651
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0270
Mailing Address - Country:US
Mailing Address - Phone:419-224-5707
Mailing Address - Fax:
Practice Address - Street 1:655 FOX RUN RD
Practice Address - Street 2:SUITE E
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8401
Practice Address - Country:US
Practice Address - Phone:419-425-5651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty