Provider Demographics
NPI:1942041140
Name:MAINLINE VEIN AND WOUND CARE CENTER LLC
Entity type:Organization
Organization Name:MAINLINE VEIN AND WOUND CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-362-8400
Mailing Address - Street 1:333 E CITY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:333 E CITY AVE FL 2
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1512
Practice Address - Country:US
Practice Address - Phone:845-362-8400
Practice Address - Fax:845-362-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center