Provider Demographics
NPI:1629749114
Name:MINIMALLY INVASIVE VASCULAR ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE VASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SILAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-682-0651
Mailing Address - Street 1:4200 LITTLE BLUE PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-8320
Mailing Address - Country:US
Mailing Address - Phone:816-648-6482
Mailing Address - Fax:855-618-2442
Practice Address - Street 1:4200 LITTLE BLUE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-8320
Practice Address - Country:US
Practice Address - Phone:816-648-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty