1396868998 NPI number — VASCULAR CARE INTERNATIONAL, INC.

Table of content: (NPI 1396868998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396868998 NPI number — VASCULAR CARE INTERNATIONAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR CARE INTERNATIONAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396868998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12966 COUNTY ROAD 153
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LIBERTY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43319-9431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-642-4100
Provider Business Mailing Address Fax Number:
937-642-4104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12966 COUNTY ROAD 153
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LIBERTY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43319-9431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-642-4100
Provider Business Practice Location Address Fax Number:
937-642-4104
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
CASSANDRE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-642-4100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0553579000 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 244562 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 117263 . This is a "AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 294349 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5319603 . This is a "AETNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76379MDI . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: A1309454 . This is a "OXFORD HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 703985 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000375906 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: N46792 . This is a "HEALTHNET PHS" identifier . This identifiers is of the category "OTHER".




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