Healthcare Provider Details

I. General information

NPI: 1578088787
Provider Name (Legal Business Name): VACCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W BROAD ST STE 320
COLUMBUS OH
43222-1478
US

IV. Provider business mailing address

815 W BROAD ST STE 320
COLUMBUS OH
43222-1478
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-0222
  • Fax: 614-221-9222
Mailing address:
  • Phone: 614-221-0222
  • Fax: 614-221-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS A STOYCHEFF
Title or Position: PHYSICIAN/MEDICAL DIRECTOR
Credential: MD
Phone: 614-221-0222