| Organization Name: | CLEARWATER VEIN CARE CENTER PC |
| NPI Number: | 1174693196 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALAN G MUENCH (PRESIDENT) |
| Mailing Address: | 3316 1/2 4th St Suite 4b Lewiston |
| State: | ID US |
| Postal Code: | 835014460 |
| Phone Number: | 2087987600 |
| Fax Number: | 2087987602 |
| NPI Enumeration Date: | 11/08/2006 |
| NPI Last Update Date: | 12/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MD00045914 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |