Provider Demographics
NPI:1538289152
Name:SOUTHWEST VASCULAR INSTITUTE LTD
Entity Type:Organization
Organization Name:SOUTHWEST VASCULAR INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:623-435-1954
Mailing Address - Street 1:6677 W THUNDERBIRD RD
Mailing Address - Street 2:G 116
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3709
Mailing Address - Country:US
Mailing Address - Phone:623-435-1954
Mailing Address - Fax:623-435-1955
Practice Address - Street 1:6677 W THUNDERBIRD RD
Practice Address - Street 2:G 116
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3709
Practice Address - Country:US
Practice Address - Phone:623-435-1954
Practice Address - Fax:623-435-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62184Medicare ID - Type Unspecified