Provider Demographics
NPI:1770951915
Name:TRI-COUNTY VASCULAR CARE, LLC
Entity type:Organization
Organization Name:TRI-COUNTY VASCULAR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:669-266-6359
Mailing Address - Street 1:393 BLOSSOM HILL RD STE 365
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1659
Mailing Address - Country:US
Mailing Address - Phone:408-225-2005
Mailing Address - Fax:408-225-2248
Practice Address - Street 1:393 BLOSSOM HILL RD STE 365
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1659
Practice Address - Country:US
Practice Address - Phone:650-400-3637
Practice Address - Fax:650-625-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical