Basic Information
| Provider Information | |||||||||
| NPI: | 1134407158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS VASCULAR CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 PALM HARBOR BLVD STE A | ||||||||
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| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346831930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274740090 | ||||||||
| FaxNumber: | 7274740055 | ||||||||
| Practice Location | |||||||||
| Address1: | 4519 WOODRUFF RD STE 17 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319046091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062218999 | ||||||||
| FaxNumber: | 7062218809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2011 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | DEES | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7274740090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 54214 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.