Provider Demographics
NPI:1639863863
Name:GHGB-I PLLC
Entity Type:Organization
Organization Name:GHGB-I PLLC
Other - Org Name:COPPER STATE VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECKHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-510-3079
Mailing Address - Street 1:535 E MCKELLIPS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2525
Mailing Address - Country:US
Mailing Address - Phone:480-510-3079
Mailing Address - Fax:
Practice Address - Street 1:535 E MCKELLIPS RD STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2525
Practice Address - Country:US
Practice Address - Phone:480-510-3079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty