Basic Information
| Provider Information | |||||||||
| NPI: | 1326430497 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCUCARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3530 E SPAULDING AVE | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810082209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192960023 | ||||||||
| FaxNumber: | 7192969001 | ||||||||
| Practice Location | |||||||||
| Address1: | 3530 E SPAULDING AVE | ||||||||
| Address2: | |||||||||
| City: | PUEBLO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810082209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192960023 | ||||||||
| FaxNumber: | 7192969001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2015 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | MEHALL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7197767602 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.