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General NPI Number Information
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NPI Number | 1225857501
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Entity Type | Organization
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Legal Business Name | VASCULAR IMAGING SOLUTIONS LLC
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 13660 N 94TH DRIVE SUITE D-3
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City | PEORIA
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State | AZ
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Zip | 85381-4836
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Country | US
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Telephone | 480-450-4511
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Fax | 602-960-1414
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Provider Business Mailing Address
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Address Line | 13660 N 94TH DRIVE SUITE D-3
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City | PEORIA
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State | AZ
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Zip | 85381-4836
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Country | US
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Telephone | 480-450-4511
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Fax | 602-960-1414
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Authorized Official
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Title or Position | OWNER/CEO
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Name | THOMAS HAGEMAN
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Credential | RVT
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Telephone | 602-930-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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