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General NPI Number Information
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NPI Number | 1255091955
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Entity Type | Organization
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Legal Business Name | ADVANCED VASCULAR CENTERS EUGENE LLC
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1200 GATEWAY LOOP
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1176
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Country | US
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Telephone | 503-683-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 GATEWAY LOOP
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City | SPRINGFIELD
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State | OR
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Zip | 97477-1176
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Country | US
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Telephone | 503-683-7730
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES T MCGLADE
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Credential | MD
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Telephone | 503-683-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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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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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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