Provider Demographics
NPI:1518338565
Name:ADVANCED VASCULAR CARE INC
Entity Type:Organization
Organization Name:ADVANCED VASCULAR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL CLAIM SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CIMCS
Authorized Official - Phone:850-543-8960
Mailing Address - Street 1:4516 E HIGHWAY 20
Mailing Address - Street 2:SUITE 226
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9755
Mailing Address - Country:US
Mailing Address - Phone:305-662-5200
Mailing Address - Fax:305-284-7913
Practice Address - Street 1:2010 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1352
Practice Address - Country:US
Practice Address - Phone:305-662-5200
Practice Address - Fax:305-284-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063852192OtherNPI
14V4QOtherBC
FL011996100Medicaid
14V4QOtherBC