Provider Demographics
NPI:1770889388
Name:INTERVENTIONAL AND VASCULAR CONSULTANTS PC
Entity type:Organization
Organization Name:INTERVENTIONAL AND VASCULAR CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-612-0498
Mailing Address - Street 1:25030 SW PARKWAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9816
Mailing Address - Country:US
Mailing Address - Phone:503-612-0498
Mailing Address - Fax:503-459-0521
Practice Address - Street 1:25030 SW PARKWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-612-0498
Practice Address - Fax:503-459-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR158533Medicare PIN