Provider Demographics
NPI:1851171409
Name:VASCULAR SURGERY CENTER OF EXCELLENCE PLLC
Entity Type:Organization
Organization Name:VASCULAR SURGERY CENTER OF EXCELLENCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:MCNAMARA
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-429-4013
Mailing Address - Street 1:1205 WHITE BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6058
Mailing Address - Country:US
Mailing Address - Phone:231-429-4013
Mailing Address - Fax:
Practice Address - Street 1:512 POLE LINE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6367
Practice Address - Country:US
Practice Address - Phone:231-429-4013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty