Basic Information
| Provider Information | |||||||||
| NPI: | 1356012256 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VSI RAD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5927 SW 70TH ST # 439031 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056662427 | ||||||||
| FaxNumber: | 3056661065 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 SW 75TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331552805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052645252 | ||||||||
| FaxNumber: | 3056661065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2021 | ||||||||
| LastUpdateDate: | 09/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | CLAYTON | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | ASHLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3055981555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VSI RAD LLC | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.