Provider Demographics
NPI:1134773401
Name:VASCULAR SURGERY CLINIC OF AMCH
Entity type:Organization
Organization Name:VASCULAR SURGERY CLINIC OF AMCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, COO, CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-262-3125
Mailing Address - Street 1:43 NEW SCOTLAND AVENUE
Mailing Address - Street 2:MC-13
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:866-242-7476
Mailing Address - Fax:518-262-6316
Practice Address - Street 1:391 MYRTLE AVENUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-262-5640
Practice Address - Fax:518-262-5110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBANY MEDICAL CENTER HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03000364Medicaid