Provider Demographics
NPI:1104841063
Name:VASCULAR & HAND SURGERY, LTD
Entity Type:Organization
Organization Name:VASCULAR & HAND SURGERY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KOSIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-233-2500
Mailing Address - Street 1:311 W LINCOLN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1902
Mailing Address - Country:US
Mailing Address - Phone:618-233-2500
Mailing Address - Fax:618-233-2520
Practice Address - Street 1:311 W LINCOLN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1902
Practice Address - Country:US
Practice Address - Phone:618-233-2500
Practice Address - Fax:618-233-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-0056902086S0105X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL231180Medicare ID - Type UnspecifiedPROVIDER NUMBER