Healthcare Provider Details

I. General information

NPI: 1417629338
Provider Name (Legal Business Name): EVA ENDOVASCULAR ACCESS CENTERS OF AMERICA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3682 UTICA RIDGE ROAD
BETTENDORF IA
52722
US

IV. Provider business mailing address

1350 BOYSON RD STE C1
HIAWATHA IA
52233-2211
US

V. Phone/Fax

Practice location:
  • Phone: 563-279-1590
  • Fax:
Mailing address:
  • Phone: 319-654-6741
  • Fax: 563-279-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HALEY ANN SLIFKA
Title or Position: OPERATIONS ASSOCIATE
Credential:
Phone: 319-654-6741