Provider Demographics
NPI:1497862080
Name:VASCULAR ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:VASCULAR ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-538-5300
Mailing Address - Street 1:2601 KENTUCKY AVENUE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3825
Mailing Address - Country:US
Mailing Address - Phone:270-538-5300
Mailing Address - Fax:270-538-5308
Practice Address - Street 1:2601 KENTUCKY AVENUE
Practice Address - Street 2:SUITE #202
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3825
Practice Address - Country:US
Practice Address - Phone:270-538-5300
Practice Address - Fax:270-538-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01720731101Medicaid
KY65913998Medicaid
6453Medicare PIN