MEDICARE: ARTERY AND VEIN SPECIALISTS OF THE EMERALD COAST, INC.

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	2086S0129X	Vascular Surgery Physician	MD32127	AL
2	2086S0129X	Vascular Surgery Physician	75309	GA
3	2086S0129X	Vascular Surgery Physician	MD32487	SC
4	2086S0129X	Vascular Surgery Physician	ME112123	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831503911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTERY AND VEIN SPECIALISTS OF THE EMERALD COAST, INC.

Provider Business Mailing Address
First Line	:	4615 NW 53RD AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4809
Country	:	US
Telephone Number	:	850-398-2548
Fax Number	:	850-398-2548

Provider Business Practice Location Address
First Line	:	4615 NW 53RD AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4809
Country	:	US
Telephone Number	:	850-398-2548
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	GINGER LYNNE MANOS
Credential	:	MD
Telephone Number	:	850-398-2548

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	02/10/2026

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