Provider Demographics
NPI:1124165345
Name:VASCULAR SURGICAL ASSOCIATES, P. C.
Entity type:Organization
Organization Name:VASCULAR SURGICAL ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-434-0642
Mailing Address - Street 1:2 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6583
Mailing Address - Country:US
Mailing Address - Phone:423-434-0642
Mailing Address - Fax:423-434-9963
Practice Address - Street 1:2 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 11
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6583
Practice Address - Country:US
Practice Address - Phone:423-434-0642
Practice Address - Fax:423-434-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709218Medicare ID - Type Unspecified