1124165345 NPI number — VASCULAR SURGICAL ASSOCIATES, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124165345 NPI number — VASCULAR SURGICAL ASSOCIATES, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR SURGICAL ASSOCIATES, P. C.
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:
1124165345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PROFESSIONAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-6583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-434-0642
Provider Business Mailing Address Fax Number:
423-434-9963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 PROFESSIONAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-434-0642
Provider Business Practice Location Address Fax Number:
423-434-9963
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
BILLING INSURANCE
Authorized Official Telephone Number:
423-434-0642

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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