Provider Demographics
NPI:1316913643
Name:VASCULAR SURGERY ASSOCIATES OF CINCINNATI INC
Entity type:Organization
Organization Name:VASCULAR SURGERY ASSOCIATES OF CINCINNATI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PODORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-936-5280
Mailing Address - Street 1:8250 KENWOOD CROSSING WAY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3668
Mailing Address - Country:US
Mailing Address - Phone:513-936-5280
Mailing Address - Fax:513-784-0266
Practice Address - Street 1:8250 KENWOOD CROSSING WAY
Practice Address - Street 2:SUITE 225
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3668
Practice Address - Country:US
Practice Address - Phone:513-936-5280
Practice Address - Fax:513-784-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200065840Medicaid
OH0265118Medicaid
KY65933368Medicaid
CD4070Medicare PIN
OHVA9279301Medicare PIN