Provider Demographics
NPI:1467284992
Name:LIMBS VASCULAR INTERVENTIONS ASC
Entity type:Organization
Organization Name:LIMBS VASCULAR INTERVENTIONS ASC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OGHENERUKEVWE
Authorized Official - Middle Name:
Authorized Official - Last Name:ODIETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-400-9588
Mailing Address - Street 1:1825 HIGHWAY 34 E STE 3400A
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6433
Mailing Address - Country:US
Mailing Address - Phone:770-400-9588
Mailing Address - Fax:470-400-3452
Practice Address - Street 1:1825 HIGHWAY 34 E STE 3400A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6433
Practice Address - Country:US
Practice Address - Phone:770-400-9588
Practice Address - Fax:470-400-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical