| Organization Name: | COMMONWEALTH VEIN CLINIC |
| NPI Number: | 1497153084 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JACK L FOREST (CO OWNER) |
| Mailing Address: | 518 W Atlantic St Suite A South Hill |
| State: | VA US |
| Postal Code: | 239701906 |
| Phone Number: | 8047546707 |
| Fax Number: | |
| NPI Enumeration Date: | 12/12/2014 |
| NPI Last Update Date: | 12/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |