Healthcare Provider Details

I. General information

NPI: 1609012657
Provider Name (Legal Business Name): VASCULAR ACCESS CENTER OF SOUTHWEST LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SURREY ST SUITE 101
LAFAYETTE LA
70501-7618
US

IV. Provider business mailing address

PO BOX 38574
PHILADELPHIA PA
19104-8574
US

V. Phone/Fax

Practice location:
  • Phone: 337-205-4330
  • Fax: 337-205-4331
Mailing address:
  • Phone: 215-382-3680
  • Fax: 215-382-3683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD.202013
License Number StateLA

VIII. Authorized Official

Name: DR. JAMES FREDERICK MCGUCKIN
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 215-382-3680