1245047687 NPI number — ADVANCED VASCULAR SOLUTIONS

Table of content: (NPI 1245047687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245047687 NPI number — ADVANCED VASCULAR SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED VASCULAR SOLUTIONS
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:
1245047687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 N EXPRESSWAY 77/83 STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78526-4354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-504-7121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N ED CAREY DR STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-887-8898
Provider Business Practice Location Address Fax Number:
956-887-8897
Provider Enumeration Date:
12/17/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LADDEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
936-671-2135

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)