Provider Demographics
NPI:1205509742
Name:ADVANCED VASCULAR SOLUTIONS, LLC
Entity type:Organization
Organization Name:ADVANCED VASCULAR SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALHOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-581-8900
Mailing Address - Street 1:13100 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3735
Mailing Address - Country:US
Mailing Address - Phone:772-581-8900
Mailing Address - Fax:
Practice Address - Street 1:13100 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3735
Practice Address - Country:US
Practice Address - Phone:772-581-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED VASCULAR SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-30
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty