Provider Demographics
NPI:1043248859
Name:VASCULAR SPECIALISTS,PLLC
Entity type:Organization
Organization Name:VASCULAR SPECIALISTS,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CODER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-441-4376
Mailing Address - Street 1:PO BOX 7329
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7329
Mailing Address - Country:US
Mailing Address - Phone:270-441-4300
Mailing Address - Fax:270-441-4370
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 208R
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4300
Practice Address - Fax:270-441-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65945537Medicaid
KY00060Medicare PIN