MEDICARE: VASCULAR ENHANCEMENT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)		OK

General Provider Information

NPI Number	:	1447258074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASCULAR ENHANCEMENT CENTER LLC

Provider Business Mailing Address
First Line	:	8523 E 11TH ST
Second Line	:	SUITE A
City	:	TULSA
State	:	OK
Zip	:	74112-7963
Country	:	US
Telephone Number	:	918-836-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8523 E 11TH ST
Second Line	:	SUITE A
City	:	TULSA
State	:	OK
Zip	:	74112-7963
Country	:	US
Telephone Number	:	918-836-9100
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANTONY ROCKEFELLER
Credential	:
Telephone Number	:	918-836-9100

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/22/2020

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