Provider Demographics
NPI:1780211920
Name:OPEN VASCULAR ACCESS CENTER
Entity Type:Organization
Organization Name:OPEN VASCULAR ACCESS CENTER
Other - Org Name:OPEN VASCULAR ACCESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-246-5644
Mailing Address - Street 1:3106 HOUMA BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-5406
Mailing Address - Country:US
Mailing Address - Phone:646-246-5644
Mailing Address - Fax:
Practice Address - Street 1:3106 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5406
Practice Address - Country:US
Practice Address - Phone:646-246-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty