Provider Demographics
NPI:1164435152
Name:VASCULAR SPECIALISTS, LLC
Entity Type:Organization
Organization Name:VASCULAR SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TATTERSALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-877-2225
Mailing Address - Street 1:8865 W 400 N
Mailing Address - Street 2:SUITE 175
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9222
Mailing Address - Country:US
Mailing Address - Phone:219-877-2225
Mailing Address - Fax:219-877-2230
Practice Address - Street 1:8865 W 400 N
Practice Address - Street 2:SUITE 175
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9222
Practice Address - Country:US
Practice Address - Phone:219-877-2225
Practice Address - Fax:219-877-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN258490Medicare PIN