Healthcare Provider Details

I. General information

NPI: 1588993679
Provider Name (Legal Business Name): VASCULAR ACCESS CENTER OF NORTH SHORE LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 SOUTH HARRISON STREET
COVINGTON LA
70433
US

IV. Provider business mailing address

285 WILMINGTON W CHESTER PIKE
CHADDS FORD PA
19317-9039
US

V. Phone/Fax

Practice location:
  • Phone: 215-382-3680
  • Fax: 215-382-3683
Mailing address:
  • Phone: 610-558-2800
  • Fax: 610-558-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RAE CREWS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 662-579-3484