Provider Demographics
NPI:1699809459
Name:VASCULAR SURGERY ASSOCIATES OF NORTH FLORIDA PA
Entity Type:Organization
Organization Name:VASCULAR SURGERY ASSOCIATES OF NORTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-276-9514
Mailing Address - Street 1:2140 KINGSLEY AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5180
Mailing Address - Country:US
Mailing Address - Phone:904-276-7997
Mailing Address - Fax:904-276-7559
Practice Address - Street 1:2140 KINGSLEY AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5180
Practice Address - Country:US
Practice Address - Phone:904-276-7997
Practice Address - Fax:904-276-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40090Medicare ID - Type UnspecifiedGROUP PROVIDER #