Healthcare Provider Details

I. General information

NPI: 1669627105
Provider Name (Legal Business Name): VASCULAR AND ENDOVASCULAR SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 713
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

5651 FRIST BLVD SUITE 713
HERMITAGE TN
37076-2054
US

V. Phone/Fax

Practice location:
  • Phone: 615-883-4444
  • Fax:
Mailing address:
  • Phone: 615-372-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY DUNCAN
Title or Position: VP
Credential:
Phone: 615-372-5135