Provider Demographics
NPI:1215934336
Name:RICHARD W. VANIS, M.D., P.C.
Entity type:Organization
Organization Name:RICHARD W. VANIS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-574-9745
Mailing Address - Street 1:301 W HUNTINGTON DR
Mailing Address - Street 2:STE 617
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-1518
Mailing Address - Country:US
Mailing Address - Phone:626-574-9745
Mailing Address - Fax:626-574-8741
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:STE 617
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1518
Practice Address - Country:US
Practice Address - Phone:626-574-9745
Practice Address - Fax:626-574-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34782207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91629Medicare UPIN
CA1054290001Medicare NSC
W7285Medicare ID - Type Unspecified