MEDICARE: VSA VASCULAR 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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1477246429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VSA VASCULAR CENTER LLC

Provider Business Mailing Address
First Line	:	7900 SHRADER RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4215
Country	:	US
Telephone Number	:	804-288-1953
Fax Number	:

Provider Business Practice Location Address
First Line	:	6031 STAPLES MILL RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-4923
Country	:	US
Telephone Number	:	804-264-8782
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LAURA BABIK
Credential	:
Telephone Number	:	804-288-1953

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	07/03/2024

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