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General NPI Number Information
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NPI Number | 1255536496
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Entity Type | Organization
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Legal Business Name | US VASCULAR ACCESS CENTER OF PHILADELPHIA, LLC
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 4220 MARKET ST SECOND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3007
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Country | US
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Telephone | 215-386-4959
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Fax | 215-386-4950
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Provider Business Mailing Address
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Address Line | 4220 MARKET ST SECOND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3007
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Country | US
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Telephone | 215-386-4959
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Fax | 215-386-4950
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DEBBIE WELLS
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Credential |
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Telephone | 770-955-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 20461501
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License Number State | PA
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