Provider Demographics
NPI:1154421428
Name:VASCULAR ASSOCIATES, PC
Entity type:Organization
Organization Name:VASCULAR ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-629-6550
Mailing Address - Street 1:PO BOX 116976
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6976
Mailing Address - Country:US
Mailing Address - Phone:423-629-6550
Mailing Address - Fax:423-629-0612
Practice Address - Street 1:2515 DESALES AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1100
Practice Address - Country:US
Practice Address - Phone:423-629-6550
Practice Address - Fax:423-629-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721850Medicaid
TN3138958OtherBLUECROSS OF TN
TNAS26943330004OtherCIGNA COMM
TNVAMedicaid
TN========= 0014OtherCIGNA
TN=========OtherTRICARE
TNAS26943330004OtherCIGNA COMM
TNVAMedicaid
TNAS26943330004OtherCIGNA COMM
TN========= 0014OtherCIGNA