Provider Demographics
NPI:1851620249
Name:VASCULAR ACCESS CENTER OF BOLIVAR COUNTY LLC
Entity Type:Organization
Organization Name:VASCULAR ACCESS CENTER OF BOLIVAR COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-579-3484
Mailing Address - Street 1:285 WILMINGTON W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9039
Mailing Address - Country:US
Mailing Address - Phone:610-558-2800
Mailing Address - Fax:610-558-4839
Practice Address - Street 1:810 E SUNFLOWER RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2800
Practice Address - Country:US
Practice Address - Phone:215-382-3680
Practice Address - Fax:215-382-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty