Provider Demographics
NPI:1710959150
Name:VASCULAR SURGERY ASSOC PC
Entity Type:Organization
Organization Name:VASCULAR SURGERY ASSOC PC
Other - Org Name:MICHIGAN VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:810-732-1620
Mailing Address - Street 1:5020 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2919
Mailing Address - Country:US
Mailing Address - Phone:810-732-1620
Mailing Address - Fax:810-732-8559
Practice Address - Street 1:5020 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2919
Practice Address - Country:US
Practice Address - Phone:810-732-1620
Practice Address - Fax:810-732-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020B560600OtherBC/BS OF MICHIGAN
MI0B56060Medicare ID - Type Unspecified