Provider Demographics
NPI:1073148581
Name:AMPUTATION PREVENTION CENTER OF NORTH CAROLINA LLC
Entity Type:Organization
Organization Name:AMPUTATION PREVENTION CENTER OF NORTH CAROLINA LLC
Other - Org Name:VASCULAR SOLUTIONS OF NORTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-474-0090
Mailing Address - Street 1:3001 PALM HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1930
Mailing Address - Country:US
Mailing Address - Phone:727-474-0090
Mailing Address - Fax:727-474-0055
Practice Address - Street 1:1000 CRESCENT GRN STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8117
Practice Address - Country:US
Practice Address - Phone:919-897-5999
Practice Address - Fax:919-897-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty