Provider Demographics
NPI:1124411244
Name:VASCULAR SURGERY ASSOC, PC
Entity Type:Organization
Organization Name:VASCULAR SURGERY ASSOC, PC
Other - Org Name:MICHIGAN VASCULAR CENTER LAPEER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:810-732-1620
Mailing Address - Street 1:5020 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2919
Mailing Address - Country:US
Mailing Address - Phone:810-732-8559
Mailing Address - Fax:810-732-8559
Practice Address - Street 1:1122 S LAPEER RD STE C
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3387
Practice Address - Country:US
Practice Address - Phone:810-272-3880
Practice Address - Fax:810-272-3770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VASCULAR SURGERY ASSOC, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-13
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty