Provider Demographics
NPI:1790966224
Name:COMPREHENSIVE VASCULAR SERVICES LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE VASCULAR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SPADONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-6300
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1854
Mailing Address - Country:US
Mailing Address - Phone:314-644-6300
Mailing Address - Fax:314-644-2503
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-644-6300
Practice Address - Fax:314-644-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6N102086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202916011Medicaid
MO202916011Medicaid
MO000014592Medicare PIN