Provider Demographics
NPI:1154198331
Name:VASCULAR SURGERY ASSOC, PC
Entity type:Organization
Organization Name:VASCULAR SURGERY ASSOC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOT
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:810-732-1620
Mailing Address - Street 1:5054 W BRISTOL RD STE E
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2952
Mailing Address - Country:US
Mailing Address - Phone:810-600-2030
Mailing Address - Fax:
Practice Address - Street 1:5054 W BRISTOL RD STE E
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2952
Practice Address - Country:US
Practice Address - Phone:810-600-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VASCULAR SURGERY ASSOC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty