Provider Demographics
NPI:1932598976
Name:RANGER VASCULAR AND VEIN CENTER PLLC
Entity Type:Organization
Organization Name:RANGER VASCULAR AND VEIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-360-1775
Mailing Address - Street 1:1225 W FRONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2368
Mailing Address - Country:US
Mailing Address - Phone:231-360-1775
Mailing Address - Fax:
Practice Address - Street 1:1225 W FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2368
Practice Address - Country:US
Practice Address - Phone:231-360-1775
Practice Address - Fax:231-486-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE5524D261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11286550OtherCAQH ID
MI0280224OtherBCBS PIN
MI1235121989OtherINDIVIDUAL NPI
MI4211489Medicaid
MI11286550OtherCAQH ID
MI4211489Medicaid