Provider Demographics
NPI:1235274127
Name:VASCULAR SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:VASCULAR SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALDSCHMDIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-781-5006
Mailing Address - Street 1:2521 GLENN HENDREN DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3388
Mailing Address - Country:US
Mailing Address - Phone:816-781-5006
Mailing Address - Fax:816-781-9212
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 112
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-781-5006
Practice Address - Fax:816-781-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208014100Medicaid
MO202238903Medicaid
MOF82582Medicare UPIN
MOB397797AMedicare ID - Type UnspecifiedMICHAEL K. DEIPARINE,M.D.
MOC52184Medicare UPIN
MOB396697AMedicare ID - Type UnspecifiedMIKE L. WALDSCHMIDT,M.D.
MO202238903Medicaid