Healthcare Provider Details

I. General information

NPI: 1073938171
Provider Name (Legal Business Name): COLUMBUS VASCULAR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 E BROAD ST
COLUMBUS OH
43213-1692
US

IV. Provider business mailing address

9140 CORSEA DEL FONTANA WAY
NAPLES FL
34109-4397
US

V. Phone/Fax

Practice location:
  • Phone: 740-400-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA MCNAMARA
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 239-597-2010