Provider Demographics
NPI:1073578563
Name:VASCULAR ASSOCIATES OF SARASOTA
Entity Type:Organization
Organization Name:VASCULAR ASSOCIATES OF SARASOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-371-6565
Mailing Address - Street 1:600 N CATTLEMEN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6410
Mailing Address - Country:US
Mailing Address - Phone:941-371-6565
Mailing Address - Fax:941-377-7731
Practice Address - Street 1:600 N CATTLEMEN RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6410
Practice Address - Country:US
Practice Address - Phone:941-371-6565
Practice Address - Fax:941-377-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH6691OtherRR MCR
FL261402200Medicaid
FL72111OtherBCBS
FL72111OtherBCBS
FL=========OtherTAX ID