Healthcare Provider Details

I. General information

NPI: 1720138381
Provider Name (Legal Business Name): VASCULAR ACCESS CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10435 CLAYTON RD SUITE 200
SAINT LOUIS MO
63131-2909
US

IV. Provider business mailing address

12909 DES PERES WOODS DR
SAINT LOUIS MO
63131-2058
US

V. Phone/Fax

Practice location:
  • Phone: 314-753-3335
  • Fax: 314-909-0135
Mailing address:
  • Phone: 314-753-3335
  • Fax: 314-909-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN J. BANDER
Title or Position: PRESIDENT
Credential: MD
Phone: 314-753-3335