Provider Demographics
NPI:1437527181
Name:OHIO ENDOVASCULAR LLC
Entity Type:Organization
Organization Name:OHIO ENDOVASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:VITVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-282-6301
Mailing Address - Street 1:1950 NILES CORTLAND RD NE STE 12
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1077
Mailing Address - Country:US
Mailing Address - Phone:304-374-7754
Mailing Address - Fax:330-362-4169
Practice Address - Street 1:1950 NILES CORTLAND RD NE STE 12
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1077
Practice Address - Country:US
Practice Address - Phone:330-282-6301
Practice Address - Fax:330-362-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty