Provider Demographics
NPI:1215973672
Name:VASCULAR SOLUTIONS PC
Entity type:Organization
Organization Name:VASCULAR SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-544-7535
Mailing Address - Street 1:7800 PROVIDENCE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-2986
Mailing Address - Country:US
Mailing Address - Phone:704-544-7535
Mailing Address - Fax:704-544-7570
Practice Address - Street 1:7800 PROVIDENCE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2986
Practice Address - Country:US
Practice Address - Phone:704-544-7535
Practice Address - Fax:704-544-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC330004500OtherRAILROAD MEDICARE
SC182328Medicaid
NC76713OtherBCBS NC
NC8976713Medicaid
NC=========OtherEIN#
NC8976713Medicaid
A08606Medicare UPIN