Provider Demographics
NPI:1215433974
Name:VASCULAR INTERVENTIONAL & PAIN CLINIC-VIP CLINIC-VIP IMAGING CEN
Entity type:Organization
Organization Name:VASCULAR INTERVENTIONAL & PAIN CLINIC-VIP CLINIC-VIP IMAGING CEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-533-3919
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-1328
Mailing Address - Country:US
Mailing Address - Phone:859-393-3124
Mailing Address - Fax:440-332-3844
Practice Address - Street 1:3906 S DUPONT SQ STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-533-3919
Practice Address - Fax:440-332-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty