Healthcare Provider Details

I. General information

NPI: 1225857501
Provider Name (Legal Business Name): VASCULAR IMAGING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 N 94TH DRIVE SUITE D-3
PEORIA AZ
85381-4836
US

IV. Provider business mailing address

13660 N 94TH DRIVE SUITE D-3
PEORIA AZ
85381-4836
US

V. Phone/Fax

Practice location:
  • Phone: 480-450-4511
  • Fax: 602-960-1414
Mailing address:
  • Phone: 480-450-4511
  • Fax: 602-960-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HAGEMAN
Title or Position: OWNER/CEO
Credential: RVT
Phone: 602-930-1414