Healthcare Provider Details

I. General information

NPI: 1356012256
Provider Name (Legal Business Name): VSI RAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SW 75TH AVE
MIAMI FL
33155-2805
US

IV. Provider business mailing address

5927 SW 70TH ST # 439031
SOUTH MIAMI FL
33143-3527
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-5252
  • Fax: 305-666-1065
Mailing address:
  • Phone: 305-666-2427
  • Fax: 305-666-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER ASHLEY CLAYTON
Title or Position: MANAGER
Credential:
Phone: 305-598-1555