Provider Demographics
NPI:1083772727
Name:VASCULAR AND SURGERY ASSOC
Entity Type:Organization
Organization Name:VASCULAR AND SURGERY ASSOC
Other - Org Name:VASA
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-957-1411
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:#504
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-957-1700
Mailing Address - Fax:941-957-4280
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:#504
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-957-1700
Practice Address - Fax:941-957-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCD6249OtherRAIL ROAD MEDICARE