Provider Demographics
NPI:1598037822
Name:PREFERRED VASCULAR SERVICES NORTHWEST, LLC
Entity Type:Organization
Organization Name:PREFERRED VASCULAR SERVICES NORTHWEST, LLC
Other - Org Name:PREFERRED VASCULAR SERVICES OF GEORGIA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-597-2010
Mailing Address - Street 1:9140 CORESA DEL FONTANA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:239-597-2010
Mailing Address - Fax:239-597-2313
Practice Address - Street 1:711 CANTON RD NE STE 220
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8949
Practice Address - Country:US
Practice Address - Phone:404-554-2196
Practice Address - Fax:404-554-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty