1073578563 NPI number — VASCULAR ASSOCIATES OF SARASOTA

Table of content: (NPI 1073578563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073578563 NPI number — VASCULAR ASSOCIATES OF SARASOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR ASSOCIATES OF SARASOTA
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:
1073578563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 N CATTLEMEN RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34232-6410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-371-6565
Provider Business Mailing Address Fax Number:
941-377-7731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N CATTLEMEN RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34232-6410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-371-6565
Provider Business Practice Location Address Fax Number:
941-377-7731
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMSON
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
941-371-6565

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH6691 . This is a "RR MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261402200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72111 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 261402200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com