Provider Demographics
NPI:1497797401
Name:VACCA, ANTHONY C (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:C
Last Name:VACCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PARKWAY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374
Mailing Address - Country:US
Mailing Address - Phone:765-935-8802
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1101 JACKSON ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1396
Practice Address - Country:US
Practice Address - Phone:375-472-2129
Practice Address - Fax:937-547-3066
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105971207R00000X, 207RC0200X, 207RP1001X
IN02004966A207RP1001X
OH34.005077207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL264630OtherHEALTHLINK
IL036105971Medicaid
IL290014938OtherMEDICARE RAILROAD
IL081851OtherHEALTH ALLIANCE
IN300046415Medicaid
IL04132005OtherBCBS
IL036105971Medicaid