Provider Demographics
NPI:1407970858
Name:VASCULAR & THORACIC ASSOC. LTD.
Entity Type:Organization
Organization Name:VASCULAR & THORACIC ASSOC. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-764-9162
Mailing Address - Street 1:870 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7159
Mailing Address - Country:US
Mailing Address - Phone:309-764-9162
Mailing Address - Fax:309-764-9471
Practice Address - Street 1:1075 GOLDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1649
Practice Address - Country:US
Practice Address - Phone:563-328-5570
Practice Address - Fax:563-326-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03149Medicare ID - Type UnspecifiedIA MEDICARE GROUP #